Truth about the Health and Social Care Bill

Written February 2012 by

Professor Ian Banks
Dr Jacky Davis
Dr Clive Peedell
Dr David Wrigley
 
Health and Social Care Bill Briefing

This Health Bill is bad for the NHS and bad for our patients, bad policy and poor politics.
This is not a party political issue. Many doctors campaigned against New Labour’s market based NHS reforms because they believed that a publicly funded, publicly provided, and publically accountable NHS is the most cost effective and equitable way of delivering healthcare to our population.
We believe the Health and Social Care Bill is not the answer to the problems of the NHS and will in fact make things worse not better. We believe that the case for such a radical change to the NHS has not been made. There is no electoral mandate given that neither of the coalition parties stood for election on the basis of introducing such an enormous re-organisation of the NHS.
If the bill goes through costs will go up rather than down. Bureaucracy will increase from 3 layers to 7. The service will be fragmented and the transactional nature of the new healthcare market will undermine medical professionalism and the doctor patient relationship. Power will not be in the hands of doctors and patients but rather in the hands of private companies who will have an ever increasing role in both commissioning and delivering NHS care.
The number of services provided by the NHS will decline over the next few years and increasing numbers of patients will take out health insurance to widen their coverage. This process will be catalysed by the NHS efficiency drive we now see as services start to fail and commissioning groups come under enormous pressure to reduce costs. This will then place enormous financial pressure on Foundation Trusts, which will need to treat increasing proportions of private patients to stay afloat. This is why Foundation Trust hospitals will be able to earn up to 49% of their income from private patients. Where does this leave NHS patients without the financial means to go private?
There is little doubt that the intention of this bill is to denationalise the English NHS, by removing the duties and powers of the Secretary of State to provide a comprehensive service. Thus the crossbencher Lord Owen has called this the “Secretary of State abdication bill”.
Politicians claim that ‘no change is not an option’ but we must ask why. International studies show that the NHS is highly cost effective and that outcomes are rapidly improving. NHS productivity is increasing and patient satisfaction is at the highest levels ever recorded. We have to ask - what is the problem to which this legislation is the solution?
The bill is 3 times longer than the original 1948 Health Bill and is littered with 100s of new amendments. Hamish Meldrum (chair BMA) said it was “hopelessly complex”. The new Chair of the NHS National Commissioning Board, Professor Malcolm Grant, who is a lawyer, said it was “unintelligible”.
But the latest amendments in Parliament do little address the fundamental underlying structural changes of the bill that will undermine the NHS. Andrew Lansley told his backbenchers after the listening exercise in 2011 that all red lines were still in place. The government has had 18 months to listen and they have failed to do so, despite claiming that this was about listening to doctors and patients.
There is widespread recognition amongst NHS professionals that something is deeply wrong with this bill. The level of opposition is unprecedented and ranges from the usual suspects of the health unions, right through to members of the Cabinet of the Government. There are at least 23 professional groups in opposition including frontline staff as well as NHS managers. The highly critical joint editorial from the BMJ, HSJ and Nursing Times was a watershed moment.
Surveys of the RCGP have shown that the vast majority of GPs want the bill withdrawn. Doctors wish to try and improve local healthcare (via commissioning) but not via this damaging Health Bill. There is absolutely no need for this Bill for doctor led commissioning to successfully take place.
Clare Gerada (Chair of RCGP) has stated:
“GPs don’t think the bill is going to create a patient led NHS, they don’t think it is going to increase autonomy, they don’t think it is going to improve patient care, and they don’t think it is going to improve healthcare inequalities”
Professor Lyndsey Davies, Chair of the UK Faculty of Public Health, which has just publicly called for withdrawal of the bill, has stated that: “the majority of our members now believe that the Health and Social Care Bill, if passed, will damage the NHS and the health of people in England”
Mark Pearson, head of health at the OECD says
"The UK is one of the best performers in the world. But outcomes are not what you expect because there is a big reform every five years. We calculate that each reform costs two years of improvements in quality. No country reforms its health service as frequently as the UK,"
When it was put to Pearson, a respected economist, that the NHS faces its biggest upheaval in 60 years with the coalition's health bill, he said: "The NHS is so central to the political process that every politician has to promise to improve the NHS. But there's no big reform that will improve it. Better to let it bed down and tinker rather than wondering about more or less competition. It is less the type of system that counts, but rather how it is managed."
President of the RCPCH, Professor Terence Stephenson, said:
“It is clear that a substantial majority of our voting members believe that the Health and Social Care Bill carries risk for children and young people. Despite revisions and assurances from Government, there remains widespread and deep concern amongst not only our members, but also the wider health profession and public, about the Bill’s impact on patient care.”
The Medical Royal Colleges have an important role to play in opposing the bill. Their remit is teaching, training, and standards of care and for these reasons they should be very concerned about the effect of market reforms on medical training and standards.
It is common knowledge that the government has recently applied pressure to the Medical Royal Colleges not to come out publicly against the bill. How can legislation that is meant to empower us be forced through by threatening us? This behaviour is indicative of how very afraid the government are of opposition from our professional bodies.
Doctors are ready to get behind their College to back them every step of the way.
It is not too late to stop this bill. The argument that is currently being used i.e. there is more pain in stopping than dropping the bill is nonsense. If you are in a hole you should stop digging. There are many coherent suggestions as to how to stabilise the situation we now find ourselves in. Having got us into a mess it is unacceptable to use the mess as an excuse to press on with the bill in the face of opposition from the vast majority of professionals.
We must stand firmly together for what we believe is right. We must stand firmly together against political interference in our clinical judgement. Only in this way can we gain respect from those we represent and those we deal with, only in this way will we gain real influence and only in this way can we protect the profession and our patients now and in the future.




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