17 reasons to oppose Lansley’s NHS bill – and what to support

22/03/2011 Comments Off on 17 reasons to oppose Lansley’s NHS bill – and what to support

Everyone I’ve spoken to wants to oppose privatisation of the health service in England, but many said they wouldn’t know what to say about the NHS bill, currently going through Parliament, because they haven’t read it. I wrote this list of reasons why people should oppose the bill, which has been shared with my local GP Practice Patients Group, Labour Party branch, the discussion website of the housing estate where I live, several MPs and friends working in health advocacy groups in London.

17 reasons to oppose Lansley’s NHS bill – and what to support

1. The bill would privatise the National Health Service in England by removing all major bodies in the NHS from government control, either closing them or making them independent (= private). It would:

  • Remove responsibility for the NHS from the Secretary of State for Health to a new NHS Commissioning Board
  • Abolish Strategic Health Authorities. These are currently responsible for plans to improve health services in their local area, making sure they are of high quality and performing well,  increasing capacity and ensuring national priorities are integrated locally – with no intention of replacing them
  • Abolish the 151 Primary Care Trusts (PCTs). PCTs manage all aspects of primary care provided by GPs, dentists, opticians, NHS walk-in centres and NHS Direct. They purchase services from hospitals and other specialist services, such as mental health services and manage screening, patient transport and NHS pharmacies
  • Create 500-600 GP consortia in place of PCTs, who would probably hire independent bodies to manage and spend 80% of the NHS budget, some £100 billion
  • Force all NHS hospitals to become Foundation Trusts, removed from the NHS balance sheet and responsible for ensuring in their own income and sustainability
  • Privatise almost 1 million NHS staff by 2014.

2. Under European trade laws governing services (GATS), making all major NHS bodies independent from government will open the provision of health services to competition. All private providers, including large corporate heath bodies from the USA and Europe, would be able to compete for contracts. Lansley’s denial of this fact does not make it less true and expert lawyers for 38 Degrees have confirmed this is the case.

3. The NHS Commissioning Board will have a huge amount of power, and ‘local control’ may be pure spin.

4. Prior to amendment, the bill had 353 pages with 281 clauses, 234 pages of explanatory notes and an impact assessment of 165 pages. Very few people have read it all, let alone understood its consequences and costs.

5. Because of its size and complexity, most of the bill did not get proper scrutiny before or during its third reading in the Commons. Opposition in the Lords is crucial. The Tories are pushing it through far too quickly.

6. The Government has been justly criticised for constantly distorting the NHS’s record to justify restructuring it, and using “cynical and misleading” information to downplay its achievements in recent years. They have also failed to publish evidence that levels of public satisfaction with the NHS are at their highest in years, following from Labour’s inputs and increased funding.

7. The Foundation Trust Network has warned that due to the £20 billion of “efficiency savings” (= cuts) the Government has demanded, hospitals are under “financial stress that will lead to the loss of many thousands of jobs and will seriously endanger waiting times and services for vulnerable patients, as well as threatening organisational survival”. This warning, early in 2011, has proven to be true in many local areas already.

8. It is unclear:

  • Whether GPs can choose which GP consortium they join
  • What responsibilities GP consortia will have
  • Who will monitor their commissioning decisions and their spending
  • Who they will report to without Strategic Health Authorities
  • What will happen if they overspend their budgets.

9. 71% of 800 GPs surveyed by the Nuffield Trust expect that GP commissioning will force GP consortia to focus on controlling costs.

10. Squeezed by spending cuts, GP consortia may be forced to:

  • Restrict access to hospital and specialist care (indeed recent evidence shows that many GPs have begun doing this already)
  • Make decisions about whether to keep or exclude specific treatments from the NHS
  • Give patients the “choice” between paying privately for care or going without.

11. In Hounslow, as a sign of what’s to come, UnitedHealth, a profit-making corporate health company, has been brought in to cut a local GP consortium’s spending by reducing GP referrals of patients for hospital care.

12. Patients may have to lobby GPs for services and drugs, and GPs have to negotiate services for their patients that they used to be able to count on. There is evidence that this is happening already.

13. Foundation trusts may be forced to close services that don’t bring in enough income. To get more income, they will be able to take many, many more private patients than has been permissible in the past. NHS patients are likely to lose access to hospital and specialist services as a result. Waiting lists could lengthen (they already have) and private patients may begin to get preferential treatment.

14. Private providers will compete with and seek to undercut NHS providers, cherrypick which services they offer and patients they treat, no matter the protestations of Andrew Lansley or any amendments to the contrary, and will see patients needing chronic care initially, for the income, and then dump them back on the NHS, increasing costs. This too is already happening and it could end up bankrupting many GPs and hospitals.

15. Patients may be allowed to register with any GP practice. While the majority may stay with their current GP, many may decide to move away from suburban and rural practices to GPs near their workplaces. The consequences for home visiting, patient funding and GP practice size would be great. Choice of registration may be determined by economic status, existing health problems, or age. Vulnerable patients will be most affected.

16. The postcode lottery – masquerading as local choice – will not only become the rule but serves as the ethos of this new system. The evidence is that patients want quality of care in a public health service, not spurious choice.

17. The Labour Party and the Green Party are opposed to Lansley’s bill. The LibDem conference expressed major concerns about it. Some Tory MPs are also very worried, including on the Health Select Committee.

The following health professional/advocacy bodies are opposed to or have major concerns about the bill: British Medical Association; NHS Consultants Association; Royal College of GPs; Royal College of Nurses; NHS Support Federation; Foundation Trust Network; Keep Our NHS Public; Health Emergency; National Association of Links Members; NHS DirectAction; 38 Degrees; Save Our NHS (medical students).
What to support

1. All publicly funded health services should be provided by health professionals and health service bodies in the public sector. Moves to privatise GPs, hospitals, ambulance and other emergency services, dentists, administrative and financial management, and social care should be reversed. The example of privatisation of dentistry, which has meant a large proportion of the population no longer receive regular dental care, should be a warning and an example of what is coming and why it should be avoided.

2. The NHS should be based on co-operation, not competition, promoting access, quality and fairness.

3. Improvements can be made without top down re-organisation.

4. Competition within the NHS and with NHS services should not be permitted.

5. Strategic Health Authorities and PCTs should not be abolished but improved.

6. The Secretary of State and the government should remain responsible for the NHS. Hospitals and all other services should remain in the public domain.

7. The internal market, whereby Primary Care Trusts (and under Lansley’s bill GP consortia) commission services, and hospitals and others sell them those services, should be abolished. This system, instituted in 1992, is the main source of increased bureaucracy in the NHS, and a costly and inefficient way of arranging service delivery.

8. The cap on the number of private patients treated in NHS facilities should remain low and tightly controlled, and be based on an assurance that the NHS can afford to treat all patients in need of care in the public sector.

9. The siphoning off of funds from the NHS by private services who accept patients they cannot treat and then send them back to the NHS to obtain treatment should be subject to investigation and regulations developed to prevent it happening.

10. All members of both Houses of Parliament and staff of the Department of Health should be investigated to learn who has personal interests in and connections with private medicine. Those found to have such interests should be required to recuse themselves when anything related to the future of the NHS is debated in Parliament or at issue in the Department of Health.

Lansley’s bill should be withdrawn in its entirety.

What you can do

1. Write to your MP and express your concerns.

2. Join a patients advocacy group and work to save the NHS.

3. Propose resolutions in support of the NHS and against Lansley’s bill in your professional association, trade union, community group, political party branch, women’s group or students group, and send them to national bodies and members of Parliament.

4. Sign a petition:

Save Our NHS

Stand Up for the NHS

Privatisation: changing the ethos of health care delivery

15/03/2011 Comments Off on Privatisation: changing the ethos of health care delivery

RHM is about promoting sexual and reproductive health and rights globally, but sometimes it’s important to focus on what’s happening at home.

First, though, I need to acknowledge the heartbreaking devastation in Japan and say that this shouldn’t be seen as an isolated natural disaster. It (and the floods in Australia and the tsunami in Thailand before that, among others) is just the beginning of the global environmental disaster we are continually being warned about. If we don’t take heed soon, our children and grandchildren will inherit a far more frightening world to live in than we can imagine now.

And now, to the news in the UK, where a movement is growing both among health professionals and at the grassroots to stop passage of a Government bill that would dismantle and privatise our National Health Service in England. Today, at 11:45am, a special session of the British Medical Association voted “overwhelmingly” to call on the Government to withdraw the bill in its entirety. This is a major victory in an ongoing struggle to stop the privatisation of health care in the UK, which has been going on since 1992 under the last Conservative government, and which this bill would have finalised under the coalition Government in office since last May.

Privatisation means many things. First, it means changing the ethos of health care delivery from being for patients into being for consumers. Some years back, we thought it would be good to stop using the word “patient” for people such as those seeking contraception, who weren’t ill. However, the term everyone has substituted, “client”, is applied across the board and ignores the fact that most health service users are ill and may have a life-threatening condition, such as obstetric complications or breast cancer, or chronic problems, such as fistula or infertility.

A paper RHM will be publishing in May looks at why maternal morbidity is higher among immigrant women in the Netherlands than among native Dutch women. In it, the authors talk about a consumer-centred care model that is being promoted by the Dutch government, which sounds similar to what the UK government is promoting as well with their bill. They claim on both sides of the North Sea that the aim is to improve the quality of care by giving people more “choices” over the care they receive. But as this paper observes, women with a life-threatening condition such as pre-eclampsia need competent diagnosis and decisive action by health professionals – not a “choice” of where to get that help or patient-centred participation in the decision of what kind of help it is, in the consumer sense.

This distortion of the concept of “choice”, at least over here, is about turning health care provision more and more into a marketplace, where publicly funded GPs, primary care and specialist services such as mental health services, and hospitals as well, must all become independent bodies and compete with each other as regards which services they provide, what they charge for them, and also for referral of patients to them. That’s privatised medicine, I don’t care how you dress it up.

Under European Union-wide policy, if a service is not almost wholly provided by the state, as the health service in the UK here currently still is, then the rules of competition that apply to free trade would also apply to health care provision. This could potentially bankrupt publicly-funded hospitals and services. Anyone – whether a public or private health care provider – would be allowed to compete for patients and undercut each other in their efforts to do so. This is called allowing in “any willing provider” in the language of the current Government bill. Its effect would be to destroy the ethos of cooperation in the health system.

It is incredibly heartening to see so many health professionals in this country rejecting privatisation, since many of them could benefit enormously at a personal level by “going private”. The UK was recently found in a survey to be one of the most equitable health systems in the developed world. The USA, in contrast, was among the worst.

Why should we be trying to emulate and copy a model that is among the worst of its kind? Because large, private profit-making health corporations in both the USA and Europe-wide are fiercely lobbying our politicians to “let them in” and word has it that they have close contacts inside our Department of Health and give a lot of money to the campaigns of politicians in more than one of our main political parties who will support their invasion of our much-loved, publicly-funded, publicly provided NHS.

Does it need improving? Oh yes! Constantly. Is privatisation the way forward? Definitely, resoundingly not.

And now, I need to get back to editing the next journal, which has more articles on privatisation and commercialisation of sexual and reproductive health services.

Where Am I?

You are currently browsing entries tagged with health service at The Berer Blog.