The Plot Against the NHS #2
Selected excerpts from ‘The Plot Against the NHS’ by Colin Leys and Stewart Player. Chapter One is available here. I highly recommend this book available from Merlin Press for £10.
p.148~154 References in the original.
Within the BMA a strong challenge emerged to the leadership’s position of ‘critical engagement’ with the government’s plans, and a demand for outright opposition. The development of serious opposition from a large part of the medical profession, and especially from GPs , was significant, because Lansley constantly claimed to have their support.
The false case for the Health and Social Care Bill
The government’s claim that the NHS was in urgent need of further fundamental reform was also becoming more and more obviously false. During the previous ten years, while the NHS was being covertly marketized, the Labour government had raised NHS funding rapidly towards the average level of spending of the other major countries of Western Europe. Spending on the NHS still remained significantly below that of the richer EU nations, and a significant portion of the new funding was absorbed by the cost of market creation. But the extra cash also produced some important improvements. Staff levels were improved, waiting times for elective care were sharply reduced, facilities were renovated or replaced.
This was reflected in the high marks given to the NHS in the Commonwealth Fund report cited in chapter 1. And by 2010 the particular charge constantly made by the marketizers, that England lagged behing European countries in the survival rates for major killer illnesses, was ceasing to be true. Lansley repeatedly declared that a wholesale restructuring of the NHS was ‘a necessity, not an option’, and David Cameron asserted that ‘pretending that there is some “easy option” of sticking with the status quo… is a complete fiction’. But in January 2011, coinciding with the publication of the Health and Social Care Bill, a paper by the King’s Fund economist John Appleby, published in the BMJ, showed tha t the marketizers’ charge was unfounded. It turned out to rest partly on the use of European data that were not comparable with the English data (and in some cases highly unreliable), and partly on selecting static data instead of trends over time. For several of the conditions usually cited English survival rates have in fact been improving so fast over the last 30 years that if the trends continue they will overtake
European rates by 2012.
The real choice
The choice is not between change and no change. It is between handing over a public service to be developed by private enterprise in the interests of shareholders, and ensuring that it develops in the interests of the public – and as the public sees those interests, not as politicians declare them to be. To maintain that there is no capacity for improvement within public provision is empty rhetoric. What evidence is there that public servcies are incapable of change and improvement (provided they are not undermined by financial starvation or market-driven disorganization)?
Around the world there are various examples of excellent public and publicly-provided health services, and all of them need to be studied for ways to improve the NHS in England – and beginning with an examination of those that are developing within the UK itself. The national media largely ignore what occurs across our nearest borders, but what is happening there, and especially in Scotland and Wales, raise crucially important questions about the future now being charted for the NHS in England.
Looking at Scotland
Even before devolution health ministers in Westminster had been too aware of Scottish sentiment to risk pushing the internal market very far there, and the Labour-Liberal Democrat coalition governments that held office in Scotland after devolution, from 1999 to 2007, recognised that voters would not support them if they followed England’s path to a healthcare market. Scotland’s Area Health Boards remained in place, foundation trust status was not introduced, nor was payment by results. The PFI was used for three Scottish hospital-building schemes, and one Independent Sector Treatment Centre was opened at Strathco in Angus. But these measures provoked intense controversy and in 2003, responding to pressure from both doctors and the public, the coalition government ended the purchaser-provider split, restoring direct administration to the NHS in Scotland and decisively closing off the market option. Also in response to public opinion, in 2002 the Scottish Labour-Lib Dem coalition made personal care for the elderly free, instead of means-tested as in England.
The 2007 elections, however, led to the formation of a minority SNP government, and yet further departures from the market-driven policy that was being pursued in England. In 2008 hospital car parking charges – a significant deterrant for families – were abolished, except at PFI hospitals, where legal reasons prevented it; and in 2010 plans were announced to abolish prescription charges from 2011. No further PFI schemes have been undertaken. Glasgow’s biggest acute hospital is being built with public funds, the ISTC at Stracathro was taken into public ownership, and plans to outsource the management of a health centre in Lanarkshire to a private company were dropped. Out-of-hours care is publicly provided.
Perhaps most significant of all for the future, in 2009 elections were introduced for the majority of the members of Scotland’s Health Boards, beginning with two pilot schemes to be evaluated after four years. This means that in addition to professional medical judgement democratic representation, rather than individual ‘patient choice’, could become a significant element in determining the direction of future change.
In face of all this the marketizers inevitably portrey Scotland’s NHS as a failure, with the usual misuse of statistics to support their claim. For example they routinely state that Scotland’s waiting times are worse than England’s, because no element of competition has been introduced into Scotland’s. In fact an analysis of newly-consolidated data concludes that since 2005 waiting times have fallen faster in Scotland than in England. In each year since then Scotland has actually had either the second shortest or (more often) the shortest waiting times of the four nations in the UK. And over the ten years from 1999 to 2008 Scotland’s mortality rates for all causes of death declined almost exactly as fast as England’s. As Dr Matthew Dunnigan, the author of the waiting times analysis, says, the objective comparison of English health statistics with those for the three devolved nations is now a very important task.
Looking at Wales
The story in Wales has many similarities to Scotland’s. For the first eight years following devolution a Labour minority government was in office, only giving way to a Labour-Plaid Cymru coalition in 2007. But as in Scotland, even the initial Labour-led Welsh Assembly Government did not dare follow the English path. The purchaser-provider split remained, but Wales did not adopt foundation trusts or payment by results. Development remained based on collaboration and planning, rather than on a market system with legally enforcable contracts and all the tensions and extra administrative costs involved.
And after 2007, under the Labour-Plaid coalition, the purchaser-provider split was dropped. In 2009 a major reform resulted in the formation of just seven integrated Local Health Boards to plan and operate the NHS in Wales. These are very like the Area Health Boards in Scotland, but also have overall responsibility for all aspects of health, including public health, with a strong emphasis on linking health and social care.
The Local Health Boards in Wales are not elected but they must have members representing local primary care, community care, public health, local government and voluntary organizations, as well as lay members. In one Local Health Board (Powys) the purchaser-provider split was abolished earlier and the Board was integrated with primary care and community health service providers. Other Boards are set to follow suit – exactly the opposite direction of change from that taken in England, where even community health services have been forced into the marketplace.
Wales also declined to use the PFI for hospital-building, led the way (in 2007) in abolishing prescription charges, abolished hospital parking charges, and dealt with the vexed issue of means-tested personal care for the elderly by widening the definition of what is considered nursing care (and therefore free), and by setting a flat-rate contribution to the cost of personal care throughout the whole country.
Considerations for England
We need to ask ourselves why Scotland and Wales opted to keep the NHS as a public service, and even extend the principle of free acess. Longstanding Scottish and Welsh cultural traditions are certainly important, especially a deeply-embedded commitment to social democracy in public life, and in the medical profession, which politicians of all parties have to respect. But another key reason is cost. Next to education health is by far the most important and expensive devolved publis service. Even before the financial crisis politicians of all parties in Scotland and Wales realised that if they followed the English route, and allowed the costs of operating a market to start soaking up ten per cent or more of the health budget, health services would be liable to deteriorate, with dire political consequences for themselves.
They know that the public spending cuts imposed by the government in Westminster will hit Scottish and Welsh health services. But they also know that the effects will be smaller that they would have been had they opted for a market, and that whatever they have to do will have a legitimate foundation in public opinion, which remains at the base of decison-making about the NHS in both countries. And when the crisis has passed they will still have a public health service, not a three-tiered healthcare market and a low-risk playground for healthcare corporations and ‘doctorpreneurs’.
Scotland and Wales don’t exhaust the alternatives for the future in England. Other good models of publically-provided health services exist and deserve study. But the successful evolution of the NHS in the rest of the UK shows that Cameron’s assertion that ‘we can’t afford not to modernise’ – meaning that we have no alternative but to accept the abolition of the NHS as a public service – is pure bluster. It has no foundation in evidence and serves no interest except that of the private health industry. In the parts of the UK that the plot against the NHS couldn’t reach, people see through it. They know that good health care for all means excluding profit-making, and have shown that with sufficient public backing that principle can prevail. We need to insist that in England too the NHS is not for selling.
NHS news review
NHS news:
Andrew Lansley’s NHS reforms are unworkable, says review chief | Society | The Guardian
Prof Steve Field, chairman of the NHS Future Forum – set up last month to undertake the coalition’s “listening exercise” – flatly rejects the health secretary’s plan to compel hospitals to compete for patients and income, which he says could “destroy key services”. The proposal, contained in Andrew Lansley’s health and social care bill, has led key medical organisations to warn that it will lead to the breakup of the NHS and betray the service’s founding principles.
It was ‘Nurse’s Day’ on Friday.
A report from the Torygraph Junk food Britain costs the NHS more than cigarettes and alcohol – Telegraph says that obesity is a huge problem to public health. Lansley consults junk-food companies on NHS policy: McDonald’s and PepsiCo to help write UK health policy | Politics | The Guardian.
There is confirmation by Mark Britnell, an advisor to Cameron that the intention of the Con-Dems’ abolition of the NHS bill is to abolish the NHS and create a health care system based on the US insurance model. He said that the NHS “will be shown no mercy” by the Coalition.
Shameless liar Nick Clegg lies shamelessly by stating that there will be no “privatisation by the back door”. The theme is picked up by the Morning Star.
Shameless liar David Cameron lies shamelessly by claiming “… it’s because I love the NHS so much that I want to change it.”
These shameless liars raise an issue of democracy. Shameless liars deliberately decieving the electorate should be held accountable for their actions. There have been similar recent incidents in UK political history with Blair, Campbell & Co and it appears that Cameron and Clegg are following that example e.g. Clegg’s “I believe” formulation.
Cameron is expected to make a speech full of shameless lies today e.g. “this Government will never, ever take risks with the NHS”.
The BMA warns on training.
- Conservative election poster 2010
A few recent news articles concerning the UK’s Conservative and Liberal-Democrat coalition government – the ConDem’s – brutal attack on the National Health Service.
Andrew Lansley’s NHS reforms are unworkable, says review chief | Society | The Guardian
The senior doctor called in by David Cameron to review the government’s health reforms has dismissed them as unworkable and “destabilising” in provisional conclusions that could fatally undermine the plans.
Prof Steve Field, chairman of the NHS Future Forum – set up last month to undertake the coalition’s “listening exercise” – flatly rejects the health secretary’s plan to compel hospitals to compete for patients and income, which he says could “destroy key services”. The proposal, contained in Andrew Lansley’s health and social care bill, has led key medical organisations to warn that it will lead to the breakup of the NHS and betray the service’s founding principles.
In an interview with the Guardian, Field says Lansley’s plan to make the NHS regulator Monitor’s primary duty to enforce competition between healthcare providers should be scrapped. Instead it should be obliged to do the opposite, by promoting co-operation and collaboration and the integration of health services.
“If you had a free market, that would destroy essential services in very big hospitals but also might destroy the services that need to be provided in small hospitals,” says Field.
“The risk in going forward [with the bill] as it is, is [of] destabilising the NHS at a local level. It would lead to some hospitals not being able to continue as they are. If you were to say ‘we’re going to go out to competition for vascular surgery services’, University Hospital Birmingham wouldn’t be able to run their own trauma centre, for example, because you wouldn’t have the staff and the skills on site to do things and the volume of procedures needed to ensure clinical standards remain high.”
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Nurses “Holding The NHS Together” – Carter, UK
The Royal College of Nursing (RCN) today praised the vital work of nurses as they marked International Nurses’ Day. Dr Peter Carter, RCN Chief Executive & General Secretary, spoke out to highlight the work nurses carry out above and beyond the call of duty, and called for their achievements to be recognised.
Nurses’ Day was also marked by The Prime Minister, David Cameron, and key figures from across the political spectrum, including Deputy Prime Minister Nick Clegg and Leader of the opposition Ed Miliband, as well as Health Secretary Andrew Lansley. The political leaders all recorded video messages pledging their support for nursing and thanking nurses for their work. Many thousands of people have also signed a pledge in support of nurses on the RCN Nurses’ Day website.
Dr Peter Carter, RCN Chief Executive & General Secretary said: “Nurses’ Day is an opportunity for all of us, whether we are patients, nurses or politicians, to reflect on the value of a profession whose worth is clearer than ever as we deal with an aging population who increasingly need care. Medical advances are helping people to live longer, but it is nursing which can help them to live well and make those extra years worth having. I am very pleased that in spite of all that is going on in the NHS at the moment, political leaders and MPs of all persuasions have made time to recognise the value of nursing.”
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Junk food Britain costs the NHS more than cigarettes and alcohol – Telegraph
A rising tide of diseases caused by poor diet and couch potato lifestyles are costing the health service around £12bn a year – almost twice the £6.6bn spent on ill health linked to smoking and alcohol, according to research by experts from Oxford University and the World Health Organisation.
The paper, published in the Journal of Public Health, says obesity and poor diet now place “the largest economic burden” on the NHS of all lifestyle choices.
Experts said that while the individual health risks of smoking and excess drinking are high, resulting in billions spent treating liver disease and lung cancer, the far higher numbers of people eating a poor diet had a bigger overall impact on NHS costs.
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David Cameron’s health adviser has warned the NHS “will be shown no mercy” by the Coalition.
Mark Britnell, who has been advising the PM on reforms, revealed that the NHS could turn into a US-style insurance system.
The former Department of Health bureaucrat said he believed the NHS would leave operations and other procedures to the private sector, with the taxpayer picking up the bill. Unions were outraged at the remarks and they will also anger Lib Dems who have demanded big changes to Health Secretary Andrew Lansley’s reforms.
Last month, the PM ordered a pause in the plans after Lib Dem activists voted against them at their party’s conference. Mr Britnell, head of health at accountants KPMG, visited Downing Street last week to advise on NHS policy. Speaking to bosses of private health firms, Mr Britnell said: “In future, the NHS will be a state insurance provider, not a deliverer.”
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NHS reforms will provide private firms the opportunity to make big profits, one of David Cameron’s advisers has said.
Mark Britnell said the healthcare system will be transformed by the Government’s controversial reforms to become a ‘state insurance provider, not a state deliverer’ of care.
His unguarded comments to a conference of executives came as there were calls for Health Minister Andrew Lansley to water down reforms which will give the private sector a far greater role in patient care.
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Clegg in vow to listen to medics – Health – The Star
DEPUTY PM Nick Clegg told doctors and nurses in Sheffield unpopular plans to reform the NHS would be “significantly and substantially” altered after a public backlash, writes Ben Spencer.
The Hallam MP, quizzed by staff at Sheffield Children’s Hospital, pledged there would be no “privatisation by the back door”.
The Lib Dem leader hopes to reassert his party’s independence within the Coalition Government after their disastrous performance at last week’s council elections.
He told staff: “No Government has the right to change the NHS without greater consent from people within the NHS.
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A chance to move ahead / Comment / Home – Morning Star
Health professionals and patients fear NHS reforms will “destroy essential services,” senior doctor Professor Steve Field warned at the weekend.
Deputy Prime Minister Nick Clegg has vowed to veto the legislation but that’s merely as part of efforts to demonstrate a greater influence by his party following disastrous results at the ballot box last week.
It gives some perspective on his lack of understanding when he commented on a Bill that is designed to allow the backdoor privatisation of the NHS that there would be no “backdoor privatisation” of the NHS.
Health Secretary Andrew Lansley’s plans would scrap primary care trusts and strategic health authorities and give GPs control of £80 billion of NHS spending, with a remit to commission treatment and services from “any willing provider” – including private companies.
It also places a duty on watchdog Monitor to promote competition in the provision of health services and, ostensibly incidentally, removes the duty to provide a free health service from the Health Secretary’s mandate.
The clear impression is that the government is seeking to privatise the NHS. Of that there is no doubt and Prof Field made it quite clear in his comments.
“If you had a free market, that would destroy essential services in very big hospitals and also the services in small hospitals,” he said unequivocally.
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David Cameron: ‘It’s because I love the NHS so much that I want to change it’ | News
David Cameron will signal his determination to press ahead with “deep change” in the NHS, warning it faces a fundamental crisis in the future if reforms are blocked.
The Prime Minister will use a keynote speech to detail some of the reworking being done of the Government’s health service shake-up to meet widespread political and professional hostility.
But he will make clear that the controversial package drawn up by Health Secretary Andrew Lansley will not be abandoned as Labour seeks to exploit tensions within the Tory-Lib Dem coalition over the plans.
Speaking at a London hospital today, the premier is expected to say: “We save the NHS by changing it. We risk its long-term future by resisting change now.
“I know that some people still have concerns. They might be listening to this and thinking: ‘OK, but if you love the NHS so much, if you don’t want to take any risks with it, why do you want to change it?
“But this is the point: it’s because I love the NHS so much that I want to change it. It needs to change to make it work better today and it needs to change to avoid a crisis tomorrow.”
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Cameron to promise ‘no risks’ in NHS reform – UK Politics, UK – The Independent
David Cameron will today attempt to breathe life back into the Coalition’s faltering plans for the NHS.
In his first major speech on health since the controversial plans were put on hold, he will set out the case for radical reform while insisting that “this Government will never, ever take risks with the NHS”.
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BBC News – Cameron set to stand firm on need for NHS changes
David Cameron will try to rally support for planned changes to the NHS in England, in a speech to health staff.
The prime minister is expected to focus on a need for “deep change”, warning of a “crisis” if proposals are blocked.
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Medical training reforms threaten patient care | GP online
In a speech to the BMA’s Annual Conference of Junior Doctors, Dr Shree Datta, who co-chairs the BMA’s Junior Doctors Committee, said proposals laid out in Liberating the NHS: developing the healthcare workforce ‘threaten the future provision of high quality patient care as anything in the Health Bill itself’.
‘They propose to invent a new system to commission, deliver, and quality-manage training through large-scale, untested, changes to the current system,’ she said.
Dr Datta expressed concerns over the pace in which medical training reforms would be implemented. ‘I am sure many of you remember MTAS,’ she said. ‘Are we really expected to believe that, with an entirely new structure in place, the recruitment process will run smoothly in a year’s time?’
Reforms could spell the end of deaneries, leaving Health Education England in charge of training funds, Dr Datta warned. Employer-led ‘skills networks’ are beginning to appear but ‘no one knows what they are going to do,’ Dr Datta said.
‘Are employers really going to focus on investing in the long term training of doctors when they are being asked to deliver £20bn in efficiency savings?,’ she added
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