SOS NHS
This document was produced in Lewisham, but anyone who is thinking of producing something similar is welcome to use as much of it as they find helpful:
We, the undersigned residents, visitors and workers of the London Borough of Lewisham and environs state that we are opposed to the Health and Social Care Bill ’11 for the following reasons :
In 2010 the NHS was shown by the WHO to be the most efficient and one of the best health services in the world. Patient satisfaction in 2010 was at its highest ever rating.
We believe this needs to be built upon, not dismantled
A highly expensive top down re-organisation which is not based upon any evidence of success risks the health of the nation at a time when the NHS is more valued than ever before.
The NHS was built during a time of great austerity after the war – this country is in a much better economic situation than we were in’48, so the current economy is a poor excuse. In fact the NHS helps to support the economy through maintaining a healthier population and workforce as well as providing jobs and training.
There is no mandate for these changes which were not mentioned in either Conservative or LibDem manifestoes
The vast majority of those working in the sector have clearly stated that the drastic changes in the Bill are a big mistake, riddled with danger for everyone who either uses the NHS or works for the NHS in England – ie the majority of the English population
The Threat
The medical profession is an evidence based profession. There is absolutely no evidence that any of the proposed measures will be of any benefit to the wider population.
Companies who are in this for profit – meaning that money making is the primary motive, will implement methods which mean that patient health and welfare will cease to be the main priority. Where services fail, people will suffer
It is clear to us that the invasion of US-style health companies is designed to split up and fragment the historic fabric of our National Health Service.
Rather than being the central focus, patients will effectively become a means to an end – ie profit.
This attack on the health of the people of England is in particular rooted in a calculated physical and mental assault on those who cannot afford to pay for medical care. If these people are not protected then there will be a negative macro effect on society and thence upon the economy.A mutual tax payer investment in national healthcare services produces a mutual benefit - from having a healthier work force, from keeping epidemics in check, from a greater mean level of health in the population etc.
The Risk
The Bill carries huge risks to every individual and every family who wishes or needs to access NHS provision paid for through the National Insurance scheme and taxes
We believe it is completely inappropriate for patients to be trapped in a purchasing squeeze
Rather than simply focusing on patient care, GPs will be forced to consider an ever increasing and conflicting range of financial incentives and barriers.
GPs will have a contract that fixes their prime loyalty to the consortium and their shareholders who will be able to create business companies to which they can refer patients. Thus profit rather than patient care will be the main concern. In addition, the government will pay GPs if they save money for the consortium. GPs are less likely to be thinking exclusively about the patient in front of them. They will think:
- Can I save money be no referring or by doing less for this patient?
- Can I make money by referring to my own company?
- Can I avoid taking on this patient because they are likely to be expensive to the consortium?
The Bill builds in financial conflict where GP Consortia will have to grapple with catering for a potentially expensive populus eg. aging, densely populated or with a preponderance of high cost conditions, whilst also being asked to plan for savings from their annual allocation in order to stay within budget should times get tough.
The complexities of funding in the Consortia model means that this can only be sustained by letting a proportion of patients down – or by charging top ups to fill the gap.
Each time they consider a patient referral, the GP will therefore have to consider the following requirements: the viability of their practice when they are asked to save for the following year and at the same time ensure they avoid DoH outcome penalties; the bonus they will earn if they save money; financial duty to their own family income; shareholder expectations for profits. GPs will also be able to cherry pick patients. This is in direct conflict with using their funds to put patient need first – and thus constitutes a conflict of interest
This will cause a direct conflict within the treasured patient/doctor relationship with a loss of trust in the GP and constitutes a conflict of interest
A proportion of GP practices and hospitals will go bust – with no chance of rescue from the DoH. What will happen to people in these communities? Healthcare deserts are inhuman & unnecessary
Clause 4 ‘the Secretary of State’s duty as to promoting autonomy’ presents a very grave risk to the health and wealth of the country – because by leaving services at risk of failure and closure, it removes the statutory obligation to ensure that each person in every community will be able to access free healthcare at the point of need |
This free marketeering is a completely inappropriate economic model for health care because the element of risk per patient bears no relation to the ability of the patient to pay for their care.
We also note that GPs are being invited to train in marketing and other associated activities which take them away from their clinical responsibilities
Flying in the face of so called ‘choice ‘, this is an enforced and bullied market, not one of considered options
Lack of Accountability
The conflict between cost-savings, quality and safety are key faults in the proposed system. Outsourcing health services to private companies which will use commercial confidentiality to conceal much of their operations, only adds to the layers of unaccountability
Consortia are not obliged to be transparent. Their governance is decided by them. It is highly likely that many will hide behind commercial confidentiality and/or opaque processes. Their decisions will not be transparent or publicly accountable. Consortia boards as proposed will not have the necessary skills to deploy budgets appropriate to patient need.
Boards will be a business partnership – essentially an enterprise established for the benefit of the partners and shareholders.
The lack of accountability and transparency are key faults in the proposed system. 90% of all doctor consultations are with a GP, however the assessment of GP performance is problematic – it is unclear to us which measures will be used by Monitor
Past reference to the failure of ‘GP Fund-holding’, which was an integral part of the NHS internal market introduced by the Thatcher government in the 1990s demonstrates the risk.
Outsourcing the planning of the NHS to private companies is also likely to result in distorted planning decisions that benefit those companies. The root cause of these decisions are unlikely to be apparent in day-to-day business.
Patient and public involvement will be weak. There is almost no constraint on consortia by the public or by local authorities.
Public Health
We are also greatly concerned that the Public Health White Paper completely excludes reference to healthy homes or safe workplace environments. We believe we all have a right to expect our government to take responsibility for ensuring that its’ citizens have these as a fundamental human entitlement.
Profligacy
Far from the much vaunted cost saving, the cost of this ‘change agent’ bill is likely to be a massive £3bn where the cost savings will then be forced out of the patient care allocation - which have been already much reduced under the guise of shifting social care into the health budgetIt is estimated that there will be 20,900 redundancies amounting to a £1bn redundancy bill
Coupled with redundancy payments, the re-employment of a significant % of said staff, consultants and researchers demonstrates that this is therefore not a cost saving but a fabrication
It will also result in a huge increase in action costs – not a saving
Rather than safeguard our nation’s health, all this expenditure and waste will only put services at risk
This is the point where the NHS will cease to be a public service.
The transfer of £80 billion pounds of public money to GP consortia is a giant shift in power away from the underpinning principles of the NHS. GP practices who struggle to manage will choose instead to employ private contractors do the work, and their decisions will be subject to the laws of trade and competition, rather than based strictly on clinical concerns. Practices will get bigger and, like lawyers and accountants, migrate to more hierarchical organisational models which rapidly distance themselves from the patient.
The essential element of trust between patient and doctor will be shattered
Europe
This Bill is counter to the aims of the Ljubljana Charter on EU healthcare reform which recognized that ‘the improvements in the health status of the population are an indicator of development in the society’. This Bill will bring about patient detriment and undermine quality care and early intervention
The shifting of EU Competition Law into the very centre of the patient/doctor relationship by means of the full scale introduction of the external market, is at variance with the Hippocratic Ethic and is thus primary facie evidence of the inappropriateness of these measures and also promises significant future conflict if the Bill is passed, entailing highly expensive court cases from private companies battling for contracts – wasting monies which should far better be spent on patient care, particularly at a time when frontline budgets are being cut.
This is a recipe for chaos and must be stopped.
We note that this is only to apply in England. Wales and Scotland with their devolved powers have developed integrated models of delivery which are starting to meet patient needs in a cost effective and co-productive way where the internal market has been declared void. Why are people in England to be treated so differently and with an unproven and dangerous model?
Un-Parliamentary
The false promise by each of the current ruling parties that they would protect the NHS and the total absence of these measures in either manifesto makes a mockery of both the Conservative and Liberal Democrat election campaigns.
Hundreds of thousands of pounds in donations to the Conservative Party from private health companies accompanied by the railroading of the contents of the Bill through the medical profession even before it has been presented to the Lords presents to us as being a corruption of statutory process and protocol.
Unison described the reforms as a Lansley “vanity project” for health secretary which was “unnecessary, badly-timed, ill-thought through and damaging”. Head of Health, Karen Jennings said: “Lansley’s so-called consultation was a sham and a foregone conclusion. By forging ahead with his plans in the teeth of fierce opposition from leading health experts, patient groups, staff, unions and GPs themselves, he is showing an utter disregard for the long term future of the NHS.”
We also believe the ‘listening exercise’ to be a mere façade for continuing these undemocratic reforms unabated and outside Parliamentary protocol. We also challenge the integrity and balance of the Future Forum due to the appointment of personnel to key posts who have a track record of clear bias to the market, whilst ignoring those who may take another view.
The Voices of Knowledge and Experience
For the sake of the nation – both our people and our economy, the people of Lewisham would urge the Secretary of State and the Cabinet to listen to the voices of reason and the voices of skill, knowledge and experience – namely, the BMA, RCGP, RCN, RSM, SoP, SCoR etc etc etc. – all of whom oppose the Bill content
These people know that they often have to look after patients whose care has been mismanaged in the private sector
An ideology of low taxes and maximum profit is not appropriate to running a high quality health service sufficient to national need.
The current issues surrounding the complex pricing structures around the privatised energy providers should give the government due warning that this model will simply not work in the far more complex arena of healthcare provision
The obliteration of national and regional management of health means that doctors are going to have to spend a great deal more of their time on business management – meaning less time for patient care. Doctors spend many years training in medicine, not accountancy. This is for a reason.
Evidence from research demonstrates that where the quality of managers increases, the quality of care does so too – this means that trained management is crucial, and GPs are not business managers.
The proposed model will only make it more difficult for GPs and hospital doctors to collaborate or for different providers to work together efficiently and for the benefit of patients
The Bill is thus a direct threat to the delivery of quality healthcare
The Patients
Whilst we like the recognition of the patient voice ‘Nothing About Me Without Me’ – we believe the development and implementation of integrated care pathways to provide seamless care for patients is an ideal which is not remotely compatible with enforced competition between providers, as proposed in the Bill.
When the safety net of a duty to provide is taken away – what of the patients who cannot afford to pay for their care?
What of those patients with multiple and complex needs or long term chronic conditions? GPs themselves say that they are not trained to know the best treatment. How exactly will these vital needs be met?
Where GP Consortia or a hospital runs out of funds, local families will have a stark choice – pay the new private provider or do without. People will die in pain and suffering as a result
Elderly residents of Lewisham repeatedly say that this will be worse than before the War - such cruelty is not necessary
The question must thus urgently be asked. Who is going to act as advocate for the patient and ensure all of these conflicts of interest are addressed?
If the Health and Social Care Bill is not stopped, we will speedily return to the postcode lottery, people we die on trolleys in corridors, others will suffer without any help, hospitals will be taken over by the private sector and many treatments will be out of reach for those who cannot purchase outright or afford top ups.
Given what we now know about how to make the system work for the greater good and this Bill means that this will be ignored, we deem the content of The Health & Social Care Bill ’11 to be an affront and an infringement of the human rights of the people of England
~ for we now have the knowledge about the best way to protect human life - and that knowledge will be squandered in the name of profit for the few at the expense of the many
William Beveridge – founding father of the NHS
‘The object of government in peace and in war is not the glory of rulers or of races, but the happiness of the common man (sic )……...Want is one only of five giants on the road of reconstruction; the others are Disease, Ignorance, Squalor, and Idleness ’
The National Health Service is one of the fundamental and civilized bedrocks of British society and one which we do not wish to be deconstructed – at direct risk of undoing all that we have achieved.
THE IMPACT UPON THE HEALTH OF THE NATION
The population of England will bear the brunt of the Bill, but afterwards Scotland, Wales and Northern Ireland will experience the fallout from the economic downturn which will result in England.The price for the nation’s health and well being is high indeed. The only thing that stands between this Bill and national disaster are those of good conscience in the Commons and the Lords for whom this travesty of consultation and implementation is just one unhealthy step too far.
This is indeed the time to be counted.
PLEASE VOTE AGAINST THE LANSLEY BILL
Yours sincerely the people and friends of the London Borough of Lewisham
Signators from : Lewisham & Deptford, Lewisham East, Lewisham West, Lewisham LINk, Lewisham Council, VA Lewisham, Trades Council, Lewisham Disability Coalition, Lewisham Pensioners Forum; BMA Division; RCN,Soc Physio, Speech & Language Service, SHA, UNITE, general public.