David Price https://www.opendemocracy.net/taxonomy/term/10320/all cached version 14/02/2019 10:15:29 en Why we need a political campaign to reinstate the NHS in England https://www.opendemocracy.net/ournhs/allyson-pollock-david-price/why-we-need-political-campaign-to-reinstate-nhs-in-england <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>This extract is from the forthcoming publication on the future of the national health service for <a href="http://classonline.org.uk/">the Centre for Labour and Social Studies (Class)</a></p> </div> </div> </div> <div class="entry-content"> <p><em>(This article originally appeared at <a href="http://www.leftfootforward.org/2013/03/why-we-need-a-political-campaign-to-reinstate-the-nhs/">Left Foot Forward</a>, cross-posted with thanks)</em></p><p>At 2.36 on the afternoon of Tuesday 27 March, 2012 the Health and Social Care Bill 2011, repealing the legal foundations of the NHS in England, was given royal assent and became law.</p> <p>Campaigning groups, NHS staff and professional organisations had fought for nearly 2 years against what must count as one of the most regressive pieces of UK legislation of the last 60 years.</p> <p>That the bill became law in the end is testimony not to our robust democratic processes <strong>but to the autocratic power of government</strong>. The coalition came to office in May 2010 on a manifesto promising no further top-down reform of the NHS, and then promptly did the opposite.</p> <p><span>&nbsp;</span>The bill passed into law without an electoral mandate because no major political party or parliamentary institution in England was willing or able to defend the NHS. It was a constitutional outrage. Its passing marked the end of a National Health Service in England that for more than sixty years served as one of the most successful models in the world, widely praised and copied.</p> <p>The UK NHS was created by national consensus <strong>in order to ensure that every citizen was guaranteed health care. </strong>Underpinning these arrangements was the secretary of state’s core duty to provide or secure a comprehensive health service, a duty repealed by the first clause of the Health and Social Care Act.</p> <p>Repeal was the fulcrum of the free market agenda because the duty compelled the minister to allocate resources according to need instead of leaving allocation to market forces and unaccountable organisations.</p> <p>In the absence of a ministerial responsibility, it now becomes possible to blur the boundaries between free health care and chargeable health and social care. Many NHS services are being transferred to local authorities, which can charge for care.</p> <p>The Act also <strong>abolishes rules that make certain health services mandatory</strong>. Under this system, players in the health care market can choose the services they wish to provide and the patients for whom they provide.</p> <p>The principle is not, as the coalition repeatedly claimed, increased patient choice but increased choice of patient.</p> <p>The NHS has been<strong> an international model</strong> because it provided what no other country in the world has achieved at the same cost: universal health care in the form of equal access to comprehensive care irrespective of personal income.</p> <p>For most of its existence the NHS was based on the principle that the poor, the chronically sick and the frail elderly would receive the best available care only if the rich received the same service. Since the 1970s and throughout the 1990s, we have witnessed a dismantling of publicly-funded and provided long-term care including nursing care for the elderly and the huge inequalities that have accompanied it.</p> <p>As the 2012 Act is being implemented, corporations will have more say in determining our entitlement to free health services. In future, no single organisation will be responsible for ensuring the health care of all residents within an area and it will no longer be clear who should be held accountable when things go wrong.</p> <p>Our relationship with our doctor will change when for-profit companies run more services. According to the <em>Financial Times</em>, Virgin already earns <a href="http://www.ft.com/cms/s/0/087158f6-3f0a-11e2-9214-00144feabdc0.html#axzz2IsoYpv5t">around £200 million a year by running more than 100 NHS services nationwide, including GP surgeries.</a></p> <p>As patients we will no longer necessarily come first: <strong>how can we feel confident that our doctor is putting us first when he or she is a for-profit company employee</strong>?</p> <p><strong>It is clear that the government is manufacturing a crisis</strong>, reducing the level of services and their quality, and shaking public confidence in the NHS. But claims that we can no longer afford the NHS are untrue. The NHS is not over budget. Last year the NHS budget was under spent and <a href="http://www.publications.parliament.uk/pa/cm201213/cmselect/cmpubacc/389/389.pdf">£2 billion was returned to the Treasury</a>.</p> <p>This year it s a similar story. Headline stories about hospital and other health service deficits only mean that resources are unfairly distributed not that the NHS is unaffordable overall.</p> <p>The answer of course is political not financial. <strong>A new Act is needed to reinstate the NHS</strong>. These changes are the culmination of a transition from public to private responsibility as market dogma has penetrated, only to abolish, an institution that has defined us in our own eyes and internationally.</p> <p>By removing the mandate on government to provide a health service, the Health and Social Care Act 2012 is <strong>the crowning achievement of the architects of this long recessional from universality</strong>. Our response must be political too.</p><p>&nbsp;</p><p><em>&nbsp;</em></p> </div><div class="field field-country"> <div class="field-label"> Country or region:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> UK </div> </div> </div> <div class="field field-topics"> <div class="field-label">Topics:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> Civil society </div> <div class="field-item even"> Democracy and government </div> </div> </div> ourNHS uk ourNHS UK Civil society Democracy and government David Price Allyson Pollock Thu, 28 Mar 2013 10:46:14 +0000 Allyson Pollock and David Price 71872 at https://www.opendemocracy.net Briefing paper - the NHS reinstatement bill https://www.opendemocracy.net/ournhs/allyson-pollock-david-price-louisa-harding-edgar/briefing-paper-nhs-reinstatement-bill <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>An explanation of what David Owen's new bill is trying to achieve and why it is needed</p> </div> </div> </div> <p><strong>&nbsp;The Abolition of the democratic and legal basis for the NHS in England</strong></p><p>The democratic and legal basis for the NHS in England was abolished by the Health and Social Care Act 2012. The impact of this fundamental change is already being felt, ahead of the shift to the new market system in April 2013.&nbsp;&nbsp; </p><p>The Act ended the Secretary of State’s duty to secure or provide health services throughout the country, a duty that had been in force since 1948. </p> <p>A minister may only be held to account legally for services that he or she is responsible for by law. In future, if we can’t get the health care we need, ministers won’t have to worry about being taken to court on this count, and there will be no Primary Care Trust to put pressure on.&nbsp; This means fewer rights for people in England to get the health care we need – at a time of unprecedented cuts and closures.</p> <p>The Act breaks up the universal system that has served us for over sixty years, and reduces the NHS to a stream of taxpayer funds and a logo for the use of a range of public and corporate providers of services. </p> <p>A House of Lords’ bill published this week will reinstate the Secretary of State’s legal duty to provide the NHS in England and the right of all of us in England to comprehensive and integrated health care. </p> <p>By restoring the legal and democratic basis, the new National Health Service (Amended Duties and Powers) Bill will ensure basic questions about citizens’ rights will continue to be determined democratically, as they should be. </p> <p>This briefing explains what the government is doing and why an urgent bill to reinstate the NHS in England is required<em>.</em><em>&nbsp;</em></p> <p><strong>What does the government’s Act mean for me? </strong></p> <p><strong>Cutting free NHS services</strong> </p> <p>When the 2012 Act is implemented, the government will no longer be responsible for providing for our health care needs free of charge. The system of health care which has served all people throughout England for over sixty years is being dismantled and broken up. Instead a range of bodies, including for-profit companies, will decide which services will be freely available and who will receive them. </p> <p>Currently many NHS services are being transferred to local authorities. They can bring in commercial companies to run them and the 2012 Act provides new charging powers. During the passage of the Health and Social Care Bill last year these services included<a href="#_edn1">[1]</a>:</p> <ul><li>immunization, cancer and cardiovascular screening</li><li>mental health care</li><li>dental public health</li><li>public health </li><li>sexual health services</li><li>management of drug and alcohol addiction</li><li>emergency planning and health protection service</li><li>child health services.</li></ul><ul><li> </li></ul><p>Concerns were repeatedly raised during the passage of the Bill that some services would no longer required by law to be provided free of charge. These services included:&nbsp; <a href="#_edn2">[2]</a></p> <ul><li>Services and facilities for pregnant women, women who are breast-feeding </li><li>Services for both younger and older children</li><li>Services for the prevention of illness</li><li>Care of persons suffering from illness and their after-care</li><li>Ambulance services</li><li>Services for people with mental illness</li><li>Dental public health services</li><li>Sexual health services</li></ul> <p><strong>Putting commercial companies in control</strong></p> <p>The Act also promotes more marketisation. More and more NHS services are being put out to tender to for-profit companies and taxpayer funds are being given to commercial corporations whilst publicly run health facilities are closed down.</p> <p>As the 2012 Act is being implemented, corporations will have more say in determining our entitlement to free health services. In future, no single organisation will be responsible in our area for ensuring all our care.&nbsp; And it will no longer be clear who should be held accountable when things go wrong. </p> <p>Our relationship with our doctor will change when for-profit companies run more services. As a patient we will no longer necessarily come first: how can we feel confident that our doctor is putting us first when he or she is a for-profit company employee? </p> <p>Privatisation and marketization has increased in advance of the Act.</p> <p>Some services, including those for the most vulnerable people in society, were last year contracted out to for-profit companies such as Virgin and Serco, which have little or no experience in delivering care. These include services for children with mental health problems and physical disabilities in Devon<a href="#_edn3">[3]</a>, and community nursing and health visitor services in Surrey<a href="#_edn4">[4]</a> and Suffolk<a href="#_edn5">[5]</a>.</p> <p>Many NHS hospitals are owned and operated under the expensive private finance initiative, creating serious financial problems for them and putting neighbouring hospitals and services at risk. For-profit companies and investors now control GP practices and other local health services. According to the Financial Times, Virgin already earns around £200 million a year by running more than 100 NHS services nationwide, including GP surgeries.<a href="#_edn6">[6]</a> A private company registered in the Virgin Islands now manages the local hospital in Huntingdon, Hinchingbrooke NHS Trust.</p> <p><strong>The government is manufacturing a financial crisis in the NHS. </strong></p> <p>It is clear that the government is manufacturing a crisis, reducing the level of services and their quality, and shaking public confidence in the NHS. We are being encouraged to accept the principle that we will in future have to pay privately for services that were once free.</p> <p>But claims that we can no longer afford the NHS are untrue. </p> <p>The NHS is not over budget. Last year the NHS budget was underspent and £2 billion was returned to the Treasury.<a href="#_edn7">[7]</a> Headline stories about hospital and other health service deficits only mean that resources are unfairly distributed not that the NHS is unaffordable overall.</p> <p>Government claims that it is protecting the NHS budget are also untrue.</p> <p>According to the official watchdog, the Statistics Authority: “expenditure on the NHS in real terms was lower in 2011-12 than it was in 2009-10.”<a href="#_edn8">[8]</a></p> <p>The NHS is being run as if it is in a financial crisis but this crisis is of the government’s making. Current plans for cutting NHS budgets, hospital beds and sacking thousands of vital NHS staff are based on documents drawn up by management consultancy firms including the US company, McKinsey &amp; Co. The policy will lead to closure and hollowing out of public services and the creation of opportunities for an expanded market for private provision and the introduction of user charges. </p> <p>The policy is fuelling cuts, closures and mergers on a scale that is unparalleled. There is no evidence to support change on this scale nor the unfair distribution of funds<a href="#_edn9">[9]</a>.<strong> </strong></p> <p><strong>Cuts and closures</strong></p> <ul><li>In North West London the government plans to cut 25% of beds, and throughout London at least 7 accident and emergency departments will close<a href="#_edn10">[10]</a>, with further departments under threat. Up to 5600 jobs in North West London will be lost by 2015<a href="#_edn11">[11]</a>.&nbsp; Barnet and Chase Farm Hospitals NHS Trust is cutting 208 posts.<a href="#_edn12">[12]</a></li><li>In Merseyside, 4000 NHS jobs will go by 2014<a href="#_edn13">[13]</a></li><li>In South Yorkshire, Rotherham Hospital is set to lose 750 staff by 2015<a href="#_edn14">[14]</a></li><li>In West Suffolk, Serco is planning to cut 137 Community Healthcare jobs.<a href="#_edn15">[15]</a></li><li>In Devon and Exeter, the Royal Devon and Exeter NHS Foundation Trust plans to cut 1115 full-time equivalent posts between 2011 and 2014.<a href="#_edn16">[16]</a></li><li>In Greater Manchester, there are plans to downgrade Trafford General Hospital’s A&amp;E to urgent care and cuts to intensive care, acute surgery and children’s services. <a href="#_edn17">[17]</a> Maternity services have already closed.<a href="#_edn18">[18]</a> Salford Royal NHS Foundation Trust plans to cut 750 full-time posts by 2013. <a href="#_edn19">[19]</a> Bolton NHS trust is making 500 redundancies.<a href="#_edn20">[20]</a></li><li>In Warwickshire, the George Eliot Hospital NHS Trust plans to cut the equivalent of 257 full-time staff between 2010 and 2014.<a href="#_edn21">[21]</a></li><li>In Cornwall, Royal Hospital Truro proposed to cut 400 jobs in 2011.<a href="#_edn22">[22]</a></li><li>In Portsmouth, Queen Alexandra Hospital cut 700 jobs and shut 3 wards in 2011<a href="#_edn23">[23]</a>. </li><li>Across England, twenty four out of thirty NHS Direct call centres will close<a href="#_edn24">[24]</a></li><li>6000 nursing posts have been cut since the coalition came to power in 2010.<a href="#_edn25">[25]</a></li></ul> <table border="0" cellspacing="0" cellpadding="0" width="525"> <tr> <td width="533" valign="top"> </td> </tr> </table> <p><strong>Mergers</strong></p> <p>Hospital mergers reduce services and increase waiting times and travel distances. </p> <ul><li>Merger with North Tees was followed by closure of A &amp; E in Hartlepool in August 2011<a href="#_edn26">[26]</a> </li><li>Merger of&nbsp; South London trust is followed by recommendation of closure of &nbsp;Lewisham hospital A&amp;E. <a href="#_edn27">[27]</a></li><li>Merger of Queen Mary’s Sidcup NHS Trust (QMS), Queen Elizabeth Hospital NHS Trust (QEH) and Bromley Hospitals NHS Trust (BHT) to create a single hospital on several sites in 2009 was followed by closure of Queen Mary’s A&amp;E and labour unit in 2010.<a href="#_edn28">[28]</a></li><li>Merger of Norfolk and Waveney and Suffolk mental health trusts was followed by cuts in beds for acute mental illness and community mental health teams<a href="#_edn29">[29]</a></li><li>Barnet and Chase Farm Hospitals NHS trust currently plans a merger which is likely to result in closure of A&amp;E, maternity and paediatric services <a href="#_edn30">[30]</a>.</li><li>Merger resulted in closure of Trafford General Maternity Unit in 2010<a href="#_edn31">[31]</a> and A&amp;E is threatened.<a href="#_edn32">[32]</a></li><li>Merger with Blackburn Hyndburn and Ribble Valley (BHRV) NHS Trust in 2003 was followed by closure of Burnley A&amp;E in 2008<a href="#_edn33">[33]</a> and the paediatric inpatient ward in 2010<a href="#_edn34">[34]</a>.</li><li>Merger resulted in closure of Rochdale Infirmary, Greater Manchester A&amp;E in 2011<a href="#_edn35">[35]</a>.</li></ul> <p><strong>Why a Bill is needed to reverse the worst aspects of the Act?</strong> </p> <p>The Health and Social Care Act 2012 must be changed because it removes the democratic and legal basis of the NHS at a time when services are being cut and reconfigured on an unprecedented scale. </p> <p>The NHS was created in 1948 by a law requiring the secretary of state to fund and provide all medical, dental and nursing care to the whole population on an equitable basis throughout the country. &nbsp;This duty has been abolished. </p> <p>The government has no mandate for this Act.&nbsp; We did not vote for the abolition of our NHS. Neither was it a part of the coalition agreement. Unlike England, citizens of Scotland, Wales, and Northern Ireland will continue to have a NHS. </p> <p><strong>The purpose and limitations of the urgent Bill</strong></p> <p>The proposed legislation restores the legal and democratic basis of the NHS and the citizens’ rights ultimately to hold the Secretary of State to account.&nbsp; It will restore the Secretary of State’s duty to provide the NHS in England and gives him or her ministerial powers of direction and planning in order that the duty can be properly discharged. </p> <p>Specifically, the Bill will:</p> <ul><li>reinstate the secretary of state’s duty to provide health services that was formerly contained within sections 1 and 3 of the NHS Act 2006;</li><li>subject all NHS bodies and bodies providing services for the NHS to ministerial direction;</li><li>repeal the duty of autonomy and restore sufficient ministerial control over provision consistent with the secretary of state’s overarching duty to provide health services to the whole of England; and</li><li>give Monitor an objective, so that its purpose is to help deliver the NHS. &nbsp;</li></ul> <p class="ColorfulList-Accent11CxSpMiddle">The Bill will not require further reorganization when it is passed.</p> <p><strong>Allyson&nbsp; M Pollock</strong> (Professor of Public health research and policy, </p> <p><strong>David Price</strong> (Senior Research Fellow)</p> <p>Global health, policy and innovation unit</p><p>Centre for Primary Care and Public Health </p><p>Queen Mary, University of London</p><p>&nbsp;</p><p class="ColorfulList-Accent11">58 Turner St, London E1 2AB and R</p><p>&nbsp;</p> <hr size="1" /> <p><a href="#_ednref1">[1]</a> Pollock AM, Price, DP, Roderick, P.&nbsp; How the Health and Social care Bill2011 would end entitlement to comprehensive health care in England, January 26, 2012 DOI:10.1016/S0140- 6736(12)60119-6 </p><p><a href="#_ednref2">[2]</a> Pollock AM, Price D, Roderick P. Health an social care Bill 2011: a legal basis for charging and providing fewer health services to people in England.&nbsp; BMJ 2012;344:1729- 82</p> <p><a href="#_ednref3">[3]</a> <a href="http://www.guardian.co.uk/society/2012/jul/12/virgin-care-children-nhs-devon">http://www.guardian.co.uk/society/2012/jul/12/virgin-care-children-nhs-devon</a></p> <p><a href="#_ednref4">[4]</a> <a href="http://www.telegraph.co.uk/health/healthnews/9176733/NHS-patients-to-be-treated-by-Virgin-Care-in-500m-deal.html">http://www.telegraph.co.uk/health/healthnews/9176733/NHS-patients-to-be-treated-by-Virgin-Care-in-500m-deal.html</a></p> <p><a href="#_ednref5">[5]</a> <a href="http://www.bbc.co.uk/news/uk-england-suffolk-20395749">http://www.bbc.co.uk/news/uk-england-suffolk-20395749</a></p> <p><a href="#_ednref6">[6]</a> <a href="http://www.ft.com/cms/s/0/087158f6-3f0a-11e2-9214-00144feabdc0.html#axzz2IsoYpv5t">http://www.ft.com/cms/s/0/087158f6-3f0a-11e2-9214-00144feabdc0.html#axzz2IsoYpv5t</a></p> <p><a href="#_ednref7">[7]</a> Department of Health: Securing the future financial sustainability of the NHS, Sixteenth Report of Session 2012–13, House of Commons, Committee of Public Accounts<em> </em><a href="http://www.publications.parliament.uk/pa/cm201213/cmselect/cmpubacc/389/389.pdf">http://www.publications.parliament.uk/pa/cm201213/cmselect/cmpubacc/389/389.pdf</a></p> <p><a href="#_ednref8">[8]</a> Andrew Dilnot, (Chair of the UK Statistics Authority) Letter to Right Hon Jeremy Hunt MP, dated 4th December 2012, <a href="http://www.statisticsauthority.gov.uk">http://www.statisticsauthority.gov.uk</a></p> <p class="ColorfulList-Accent11"><a href="#_ednref9">[9]</a> ‘Can governments do it better? Merger mania and hospital outcomes in the English NHS’, M Gaynor, M Laudicella and C Propper, CMPO working paper 12/281 <a href="http://www.bristol.ac.uk/cmpo/publications/papers/2012/wp281.pdf">http://www.bristol.ac.uk/cmpo/publications/papers/2012/wp281.pdf</a></p> <p><a href="#_ednref10">[10]</a> <a href="http://www.dailymail.co.uk/news/article-2200339/NHS-Cuts--Savage-consequences-revealed-pensioner-waits-6-hours-ambulance.html">http://www.dailymail.co.uk/news/article-2200339/NHS-Cuts--Savage-consequences-revealed-pensioner-waits-6-hours-ambulance.html</a></p> <p><a href="#_ednref11">[11]</a> <a href="http://www.healthemergency.org.uk/breakingnews.php">http://www.healthemergency.org.uk/breakingnews.php</a> Tuesday 23rd October 2012</p> <p><a href="#_ednref12">[12]</a> <a href="http://www.enfield-today.co.uk/News.cfm?id=43000&amp;headline=Alarm%20over%20job%20cuts%20at%20hospital">http://www.enfield-today.co.uk/News.cfm?id=43000&amp;headline=Alarm%20over%20job%20cuts%20at%20hospital</a></p> <p><a href="#_ednref13">[13]</a> <a href="http://www.liverpooldailypost.co.uk/liverpool-news/regional-news/2012/01/19/exclusive-merseyside-nhs-staff-cuts-to-see-4-001-jobs-go-by-2014-99623-30150190">http://www.liverpooldailypost.co.uk/liverpool-news/regional-news/2012/01/19/exclusive-merseyside-nhs-staff-cuts-to-see-4-001-jobs-go-by-2014-99623-30150190</a></p> <p><a href="#_ednref14">[14]</a> <a href="http://www.bbc.co.uk/news/uk-england-south-yorkshire-20092315">http://www.bbc.co.uk/news/uk-england-south-yorkshire-20092315</a></p> <p><a href="#_ednref15">[15]</a> <a 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href="http://falseeconomy.org.uk/cuts/item/salford-royal-nhs-job-cuts">http://falseeconomy.org.uk/cuts/item/salford-royal-nhs-job-cuts</a></p> <p><a href="#_ednref20">[20]</a> <a href="http://www.bbc.co.uk/news/uk-england-manchester-20319241">http://www.bbc.co.uk/news/uk-england-manchester-20319241</a></p> <p><a href="#_ednref21">[21]</a> <a href="http://falseeconomy.org.uk/cuts/item/george-eliot-hospital-job-cuts">http://falseeconomy.org.uk/cuts/item/george-eliot-hospital-job-cuts</a></p> <p><a href="#_ednref22">[22]</a> <a href="http://www.truropeople.co.uk/groups/trurohealth/400-Jobs-Cut-Truro-Royal-Cornwall-Hospital/story-10908019-detail/story.html">http://www.truropeople.co.uk/groups/trurohealth/400-Jobs-Cut-Truro-Royal-Cornwall-Hospital/story-10908019-detail/story.html</a></p> <p><a href="#_ednref23">[23]</a> <a href="http://www.bbc.co.uk/news/uk-england-hampshire-13126925">http://www.bbc.co.uk/news/uk-england-hampshire-13126925</a></p> <p><a href="#_ednref24">[24]</a> <a href="http://www.dailymail.co.uk/health/article-2230584/NHS-Direct-close-24-30-centres-claims-union.html">http://www.dailymail.co.uk/health/article-2230584/NHS-Direct-close-24-30-centres-claims-union.html</a></p> <p><a href="#_ednref25">[25]</a> <a href="http://www.independent.co.uk/life-style/health-and-families/health-news/fears-for-patient-safety-as-60000-nhs-jobs-face-the-axe-8307270.html">http://www.independent.co.uk/life-style/health-and-families/health-news/fears-for-patient-safety-as-60000-nhs-jobs-face-the-axe-8307270.html</a></p> <p><a href="#_ednref26">[26]</a> <a href="http://www.hartlepoolmail.co.uk/news/local/a_e_decision_flawed_claim_1_3879562">http://www.hartlepoolmail.co.uk/news/local/a_e_decision_flawed_claim_1_3879562</a></p> <p><a href="#_ednref27">[27]</a> <a href="http://www.independent.co.uk/life-style/health-and-families/health-news/debtridden-nhs-trust-to-be-scrapped-8231436.html">http://www.independent.co.uk/life-style/health-and-families/health-news/debtridden-nhs-trust-to-be-scrapped-8231436.html</a></p> <p><a href="#_ednref28">[28]</a> <a href="http://www.hsj.co.uk/acute-care/nhs-london-revives-queen-marys-sidcup-closure-plans-amid-patient-safety-concerns/5019638.article">http://www.hsj.co.uk/acute-care/nhs-london-revives-queen-marys-sidcup-closure-plans-amid-patient-safety-concerns/5019638.article</a></p> <p><a href="#_ednref29">[29]</a><a href="http://www.eadt.co.uk/news/suffolk_mental_health_trust_to_slash_inpatient_bed_numbers_1_1668405">http://www.eadt.co.uk/news/suffolk_mental_health_trust_to_slash_inpatient_bed_numbers_1_1668405</a></p> <p><a href="#_ednref30">[30]</a> <a href="http://www.telegraph.co.uk/news/politics/8756245/Government-to-merge-Chase-Farm-Hospital-which-David-Cameron-vowed-to-save.html">http://www.telegraph.co.uk/news/politics/8756245/Government-to-merge-Chase-Farm-Hospital-which-David-Cameron-vowed-to-save.html</a></p> <p><a href="#_ednref31">[31]</a> <a href="http://nhsfightback.org/2013/01/03/hospitals-across-greater-manchester-under-threat/">http://nhsfightback.org/2013/01/03/hospitals-across-greater-manchester-under-threat/</a></p> <p><a href="#_ednref32">[32]</a> <a href="http://www.manchestereveningnews.co.uk/news/health/trafford-health-trust-to-merge-with-neighbours-866605">http://www.manchestereveningnews.co.uk/news/health/trafford-health-trust-to-merge-with-neighbours-866605</a></p> <p><a href="#_ednref33">[33]</a> <a href="http://www.dailymail.co.uk/news/article-2207274/A-E-closures-Secret-report-reveals-lives-risk-sweeping-plans-close-25-casualty-units.html">http://www.dailymail.co.uk/news/article-2207274/A-E-closures-Secret-report-reveals-lives-risk-sweeping-plans-close-25-casualty-units.html</a></p> <p><a href="#_ednref34">[34]</a><a href="http://www.lancashiretelegraph.co.uk/news/burnley/9016530.Burnley_s_children_ward_to_stay_in_Blackburn/">http://www.lancashiretelegraph.co.uk/news/burnley/9016530.Burnley_s_children_ward_to_stay_in_Blackburn/</a></p> <p><a href="#_ednref35">[35]</a> <a href="http://www.manchestereveningnews.co.uk/news/local-news/last-chance-to-save-rochdale-infirmary-679318">http://www.manchestereveningnews.co.uk/news/local-news/last-chance-to-save-rochdale-infirmary-679318</a></p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/david-owen/bill-to-re-instate-nhs">A bill to re-instate the NHS?</a> </div> </div> </div> </fieldset> ourNHS uk ourNHS Re-instatement bill Rationing Cuts Charging and insurance Commissioning Private healthcare Allyson Pollock David Price Louisa Harding-Edgar Wed, 30 Jan 2013 09:38:33 +0000 Allyson Pollock, David Price and Louisa Harding-Edgar 70643 at https://www.opendemocracy.net The end of the NHS as we know it https://www.opendemocracy.net/ourkingdom/allyson-pollock-david-price-peter-roderick-tim-treuherz-david-mccoy-martin-mckee-lucy-rey <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>"How the Health and Social Care Bill 2011 would end entitlement to comprehensive health care in England" republished from <em>The Lancet</em> with thanks.</p> </div> </div> </div> <p>Republished from <em>The Lancet</em> with thanks. </p><p>The National Health Service (NHS) in England has been a leading international model of tax-financed, universal health care. Legal analysis shows that the Health and Social Care Bill currently making its way through the UK Parliament<a href="#1">[1]</a> would abolish that model<a href="#2">[2]</a> and pave the way for the introduction of a US-style health system by eroding entitlement to equality of health-care provision. The Bill severs the duty of the Secretary of State for Health to secure comprehensive health care throughout England and introduces competitive markets and structures consistent with greater inequality of provision, mixed funding, and widespread provision by private health corporations. The Bill has had a turbulent passage. Unusually, the legislative process was suspended for more than 2 months in 2011 because of the weight of public concern.<a href="#3">[3]</a> It was recommitted to Parliament largely unaltered after a “listening exercise”. These and more recent amendments to the Bill do not sufficiently address major concerns that continue to be raised by Peers and a Constitution Committee of the House of Lords,<a href="#4">[4,5]</a> where the Bill now faces one of its last parliamentary hurdles before becoming law.<!--break--></p> <p><div class="pullquote-right"> <em><strong>Red lines to protect the NHS</strong></em> <br />1. The Secretary of State must have the duty to secure provision of comprehensive and equitable health care for the whole of the population of England, taking action whenever there are problems <br />2. CCGs, operating on behalf of the Secretary of State, must make sure that comprehensive and equitable health care is available for everyone and be responsible for all residents living in single geographically defined areas that are contiguous, without being able to pick and choose patients. <br />3. Nothing must be done that undermines the ability of the Secretary of State to fulfil the duty to secure provision of comprehensive and equitable health care, by bringing more of the NHS within the scope of EU competition law so that, in particular: <ul><li>There must be no increase in the commercial contracting of health services;</li> <li>The current authorisation system for central regulation of Foundation Trusts must be retained; </li><li>Statutory functions of CCGs must be carried out by NHS staff, with CCG finances being used solely for the benefit of patients;</li> <li>Statutory and enforceable codes of conduct must be laid down for all NHS bodies, underpinned by sanctions that are rigorously policed;</li> <li>Information about commercial contracting, including the planning, procurement, financing, and monitoring, must be available as a matter of course.</li></ul> <small>CCGs=Clinical Commissioning Groups.</small> </div> </p><p>Fundamental to the Bill are provisions that transform a mandatory system into a discretionary one with structures that permit the introduction of charging for services that are currently free under the NHS, as well as a system in which much delivery would be privatised. Under the current statutory framework the Government has a legal duty to secure comprehensive health care, whereas, under the new system, substantial discretionary powers will instead be extended to commissioners and providers of care. These measures will increase inequalities of provision.</p> <p>Clauses 1 and 12 of the Bill will dismantle key sections of the 1946 founding legislation of the NHS by repealing the unifying duty from which all other legislative powers and functions flow.<a href="#6">[6]</a> This unifying duty is currently laid down in Sections 1 and 3 of the National Health Service Act 2006. It requires the Government to promote a comprehensive health service by providing or securing the provision throughout England of a list of specified NHS services and hospital accommodation in ways that meet all reasonable requirements. Accordingly, since 1948, most NHS hospital and community-based provision has its own facilities and NHS staff. The whole system has been publicly administered and funded on the basis of contiguous geographical areas by bodies, now called primary care trusts (PCTs), that act on behalf of the Secretary of State and have responsibility for the health-care needs of everyone in their area. Experiments with internal and external markets since 1990 have taken place within this overarching geographical framework.</p> <p>The Bill creates two new bodies with responsibility for managing care: an NHS Commissioning Board and Clinical Commissioning Groups (CCGs), the number of which remain unclear. PCTs will be abolished and not replaced. Powers currently exercised by the Secretary of State for Health will be transferred to each CCG, which, in contrast to PCTs, will act in place of, and not on behalf of, the minister. The NHS Commissioning Board will exercise its functions at a distance from the Secretary of State and have oversight of CCGs. These changes will repeal the minister’s core duty to provide or secure provision of specified health services.&nbsp;</p> <p>Clause 12 of the Health and Social Care Bill repeals the Secretary of State’s “duty to provide” specific services. Instead, a “duty to arrange” provision is imposed on each of the many CCGs that will also have transferred to them the power to determine what care is necessary to meet all reasonable requirements. However, CCGs will not have the duty to promote a comprehensive free health service. Amendments suggested by the Government in a letter to Peers from the responsible minister dated Jan 12, 2012, do not restore the duty.<a href="#7">[7]</a> Thus, the link between the duty to promote comprehensive care and the duty to provide would be severed.&nbsp;</p> <p>Although the Government has said that its intention is to “reinforce” the overarching duty to promote a comprehensive health service,<a href="#8">[8]</a> the creation of bodies that are independent of the Secretary of State for Health to support a lesser duty fundamentally affects the minister’s duty. This is because the test of whether the Secretary of State is discharging his or her duty to promote a comprehensive health service will no longer depend on whether a comprehensive service is actually provided.</p> <p>As well as transferring powers from the Secretary of State to other bodies, the Bill leaves each CCG free to choose the patients for whom they have responsibility. Unlike PCTs, CCGs will not be responsible for all residents within contiguous geographical areas. CCGs select patients, initially assembling their patient populations on the basis of general practitioners’ (GPs) lists; they will not have to cover everyone in a geographical area but only “persons for whom it [the CCG] has responsibility”. Nor will they be required to arrange for the provision of all the services that are currently part of the comprehensive health system. For example, accident and emergency services are not an explicit CCG responsibility under these proposals. Only a new category “of services or facilities for emergency care” will have to be provided for people in a CCG’s area, which need not consist of adjoining or indeed whole electoral districts, as is the case with PCTs.</p> <p>Another organisation, known as Monitor and with the functions of a regulator, is independent of the Secretary of State for Health, and will have oversight of providers (public and private) in the new system. However, it will not have a duty to promote a comprehensive service—a crucial consideration given that its decisions about the extent of competition will affect the financial viability of local services. In a parallel move, NHS hospitals that currently get most of their funding from NHS sources will be free to obtain almost half their income from private patients.</p> <p>Although there are provisions in the Bill giving the Secretary of State for Health power to regulate the new system through secondary rather than primary legislation, that power is limited by a new clause (Clause 4), under which the minister has a duty to observe the autonomy of commissioners and providers. The autonomy clause means that commercial providers can bring legal challenges against a minister who chooses to curtail their discretion. Furthermore, the adoption of compulsory market competition will bring more NHS activity under the jurisdiction of EU competition law. Competition law is designed to limit government powers of intervention and will provide a further check on secondary regulation.</p> <p>These changes will have substantial legal consequences. First, the duty to provide a national health service throughout England would be lost if the Bill became law.<a href="#9">[9]</a> It would be replaced by a duty on an unknown number of CCGs, not GPs, to arrange provision as they see fit for various sections of the population for which they are separately responsible. Second, CCGs would not be bound by the “duty to continue to promote a comprehensive free health service” when exercising their functions. Under present law, according to a judgment of the Court of Appeal, the Secretary of State “has the duty to continue to promote a comprehensive free health service and he must never, in making a decision [about services provided], disregard that duty”.<a href="#10">[10]</a> Third, the Secretary of State’s accountability to Parliament for the provision of services to patients in the new NHS will be diminished.<a href="#4">[4,</a><a href="#11">11]</a></p> <p>At the same time, a new parallel system of public health services will be established at the local level. Under this system, the provision of a range of public health services will be assigned to local authorities, including immunisation, screening, mental health, dental health, children’s services, sexual health, drug and alcohol services, and health protection programmes. However, neither services nor funding have been defined.<a href="#12">[12]</a> Moreover, in this new system local authorities will have considerable discretion to define and decide what services are provided and how. As with the social services they provide, these services may be chargeable.</p> <p>All these factors will increase inequality in service access, provision, and uptake. The abolition of PCTs and loss of overall political control will impair, or take away altogether, current information systems used to monitor inequalities at area level. The new structures for CCGs and public health create such a multiplicity of denominators, resource flows, populations, and fragmented responsibilities for care and data that systematic inequalities will cease to be identifiable and no body will have overall responsibility for an area. Furthermore, the loss of area-based population responsibilities has serious implications for the stability and accuracy of measurement of needs and equity of resource allocation and service provision. Loss of geographical population data and area-based structures and responsibilities will impair, or take away altogether, the capacity to plan health services by monitoring needs, access, service use, and health outcomes.&nbsp;</p> <p>The Government has not disclosed the radical nature of this reform. The Leader of the House of Lords, Earl Howe, told the Lords that the Bill reinforces and does not “dilute the Secretary of State’s overarching duty…Let me be clear: the Bill’s provisions would in no way dilute the Secretary of State’s overarching duty. Indeed, they are intended further to reinforce the promotion of a comprehensive health service rather than to undermine it.”<a href="#7">[7]</a> Legal analysis of the Bill shows this is not the case. Recent amendments raised for consideration in a letter of Jan 12, 2012, from Earl Howe to Peers do not substantially change the situation.<a href="#7">[7]</a></p> <p>In the USA, opposition to health reforms under both the Clinton and Obama administrations is articulated as erosion of personal freedom by increasing government powers.<a href="#13">[13]</a> Conversely, pro-market reforms of universal health systems in Europe are often justified on the grounds that they increase personal freedom by transferring powers from government to non-governmental or commercial bodies and by increasing choice. Citizens’ rights in democracies are underpinned not just by limitations on government powers but also by legal duties imposed on governments, such as those that guarantee citizens access to health care. The Bill would withdraw this legal underpinning.<a href="#14">[14]</a> As the Bill enters its final critical stages it is crucial that Peers observe three red lines for the NHS (panel)<a href="#15">[15]</a> and are fully aware of the key parts of the legislation that would abolish core NHS functions, if they are to safeguard the NHS for future generations.&nbsp;</p> <p><em>*Allyson M Pollock, David Price, Peter Roderick, Tim Treuherz, David McCoy, Martin McKee, Lucy Reynolds</em></p> <p>Centre for Primary Care and Public Health, Queen Mary, University of London, London E1 4NS, UK (AMP, DP); 101 Weavers Way, London, UK (PR); 5 Hobson Road, Oxford, UK (TT); Inner North West London Primary Care Trusts, London, UK (DM); and European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK (MM, LR)<br /> a.pollock@qmul.ac.uk</p> <p>PR is a London-based public interest lawyer who has supported 38 Degrees on an unpaid basis. TT is a non-practising barrister and formerly Head of Legal Services, Vale of White Horse District Council. The other authors declare that they have no conflicts of interest.</p> <p><strong><em>"How the Health and Social Care Bill 2011 would end entitlement to comprehensive health care in England" is republished from <em>The Lancet</em> with thanks. See also: Clare Sambrook, <a href="http://www.opendemocracy.net/ourkingdom/clare-sambrook/truth-about-health-%E2%80%9Creform%E2%80%9D-its-demolition-of-nhs">'The truth about health "reform": it's the demolition of the NHS'</a></em></strong></p> <p><strong>References:</strong></p> <p><a name="1"></a>1. House of Lords. Health and Social Care Bill 2011. HL Bill 92. ,<a href="http://www.publications.parliament.uk/pa/bills/lbill/2010-2012/0119/2012119.pdf">http://www.publications.parliament.uk/pa/bills/lbill/2010-2012/0119/2012119.pdf</a> (accessed Jan 20, 2012).</p> <p><a name="2"></a>2 Pollock AM, Price D. How the Secretary of State for Health proposes to abolish the NHS in England. <em>BMJ</em> 2011; <strong>342:</strong> 800–03.&nbsp;</p> <p><a name="3"></a>3. NHS Futures Forum. Summary Report on proposed changes to the NHS. London: London School of Hygiene and Tropical Medicine, 2011.</p> <p><a name="4"></a>4. House of Lords Select Committee on the Constitution. Health and Social Care Bill. HL Paper 197, Sept 30, 2011. London: The Stationery Office Ltd, 2011. <a href="http://www.publications.parliament.uk/pa/ld201012/ldselect/ldconst/197/197.pdf">http://www.publications.parliament.uk/pa/ld201012/ldselect/ldconst/197/197.pdf</a> (accessed Jan 20, 2012).&nbsp;</p> <p><a name="5"></a>5. House of Lords Select Committee on the Constitution. Health and Social Care Bill: Follow-up. HL Paper 240, Dec 20, 2011. London: The Stationery Office Ltd, 2011. <a href="http://www.publications.parliament.uk/pa/ld201012/ldselect/ldconst/240/24002.htm">http://www.publications.parliament.uk/pa/ld201012/ldselect/ldconst/240/24002.htm</a> (accessed Jan 20, 2012).</p> <p><a name="6"></a>6. Pollock AM, Price D, Roderick P, Treuherz T. Health and Social Care Bill, Briefing on Clause 1. 2011. <a href="http://www.allysonpollock.co.uk/administrator/components/com_article/attach/2011-10-26/AP_2011_Pollock_HouseOfLordsBriefingC1__22Oct11.pdf ">http://www.allysonpollock.co.uk/administrator/components/com_article/attach/2011-10-26/AP_2011_Pollock_HouseOfLordsBriefingC1__22Oct11.pdf</a> (accessed Jan 17, 2012).</p> <p><a name="7"></a>7. Pollock AM, Price D, Roderick P, Treuherz T. Health and Social Care Bill, Briefing note 12, Earl Howe’s response to the Constitution Committee’s follow-up report and his letter dated Jan 12, 2012. <a href="http://www.allysonpollock.co.uk/administrator/components/com_article/attach/2012-01-17/Pollock_HouseOfLords_HSCB_Briefing12_HoweLetter_17Jan12.pdf">http://www.allysonpollock.co.uk/administrator/components/com_article/attach/2012-01-17/Pollock_HouseOfLords_HSCB_Briefing12_HoweLetter_17Jan12.pdf</a> (accessed Jan 17, 2012).</p> <p><a name="8"></a>8. House of Lords Debate. Nov 14, 2011 column 494. Hansard. <a href="http://www.publications.parliament.uk/pa/ld201011/ldhansrd/text/111114-0002.htm">http://www.publications.parliament.uk/pa/ld201011/ldhansrd/text/111114-0002.htm</a> (accessed Jan 20, 2011).</p> <p><a name="9"></a>9. 38 Degrees. NHS expert legal advice. <a href="http://www.38degrees.org.uk/page/content/NHS-legal-advice">http://www.38degrees.org.uk/page/content/NHS-legal-advice</a> (accessed Jan 20, 2012).</p> <p><a name="10"></a>10. Coughlan &amp; Ors, R (on the application of) v North &amp; East Devon Health Authority [1999] EWCA Civ 1871 (July 16, 1999). <a href="http://www.bailii.org/ew/cases/EWCA/Civ/1999/1871.html">http://www.bailii.org/ew/cases/EWCA/Civ/1999/1871.html</a> (accessed Jan 20, 2012).</p> <p><a name="11"></a>11. Pollock AM, Price D, Roderick P, Treuherz T. Health and Social Care Bill 2011, House of Lords Committee Stage, Briefing Note 2, on Clause 1 for day 1 Oct 25, 2011 in the light of evidence from Professor Malcolm Grant. <a href="http://www.allysonpollock.co.uk/administrator/components/com_article/attach/2011-10-26/AP_2011_Pollock_HouseOfLordsBriefing2C2_24Oct11.pdf">http://www.allysonpollock.co.uk/administrator/components/com_article/attach/2011-10-26/AP_2011_Pollock_HouseOfLordsBriefing2C2_24Oct11.pdf </a>(accessed Jan 24, 2012).&nbsp;</p> <p><a name="12"></a>12. Pollock AM, Price D, Roderick P, Treuherz T. Health and Social Care Bill 2011, House of Lords Committee stage, Briefing Note 7, Clause 8 (Amendments 60B–75A) for Monday Nov 14, 2011. <a href="http://www.allysonpollock.co.uk/administrator/components/com_article/attach/2011-11-21/AP_2011_Pollock_HouseOfLordsBriefing7C8-9.pdf">http://www.allysonpollock.co.uk/administrator/components/com_article/attach/2011-11-21/AP_2011_Pollock_HouseOfLordsBriefing7C8-9.pdf</a>(accessed Jan 20, 2012).</p> <p><a name="13"></a>13. Starfield B. The Obama presidency: what may happen, what needs to happen in health policies in the USA. <em>J Epidemiol Community Health</em> 2009; <strong>63:</strong> 265–66.</p> <p><a name="14"></a>14. Pollock AM, Price D, Roderick P, Treuherz T. Health and Social Care Bill 2011, House of Lords Committee stage, Briefing Note 6 Clause 10. <a href="http://www.allysonpollock.co.uk/administrator/components/com_article/attach/2011-11-11/AP_2011_Pollock_HouseOfLordsBriefing6C10_11Nov11.pdf ">http://www.allysonpollock.co.uk/administrator/components/com_article/attach/2011-11-11/AP_2011_Pollock_HouseOfLordsBriefing6C10_11Nov11.pdf</a>(accessed Jan 20, 2012).</p> <p><a name="15"></a>15. Health and Social Care Bill 2011. House of Lords Report Stage. Briefing Note 10: Red Lines for Peers on the NHS Bill. Jan 9, 2011. <a href="http://www.allysonpollock.co.uk/administrator/components/com_article/attach/2012-01-09/20120109-AP_2012_Pollock_HouseOfLordsBriefing10_C1412_09Jan12.pdf">http://www.allysonpollock.co.uk/administrator/components/com_article/attach/2012-01-09/20120109-AP_2012_Pollock_HouseOfLordsBriefing10_C1412_09Jan12.pdf</a> (accessed Jan 20, 2012).</p><p></p><div class="field field-country"> <div class="field-label"> Country or region:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> UK </div> </div> </div> <div class="field field-topics"> <div class="field-label">Topics:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> Civil society </div> <div class="field-item even"> Democracy and government </div> </div> </div> uk uk UK Civil society Democracy and government OurKingdom debates the NHS Lucy Reynolds Martin McKee David Price David McCoy Peter Roderick Tim Treuherz Allyson Pollock Fri, 27 Jan 2012 13:54:00 +0000 Allyson Pollock, David Price, Peter Roderick, Tim Treuherz, David McCoy, Martin McKee and Lucy Reynolds 63885 at https://www.opendemocracy.net David Price https://www.opendemocracy.net/author-profile/david-price <div class="field field-au-term"> <div class="field-label">Author:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> David Price </div> </div> </div> <p>David Price is a senior research fellow at Queen Mary, University of London.</p><div class="field field-au-shortbio"> <div class="field-label">One-Line Biography:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> &lt;p&gt;David Price is a senior research fellow at Queen Mary, University of London.&lt;/p&gt; </div> </div> </div> David Price Thu, 24 Nov 2011 10:57:58 +0000 David Price 62810 at https://www.opendemocracy.net The abolition of the NHS. That’s what is happening. https://www.opendemocracy.net/shinealight/allyson-pollock-david-price/abolition-of-nhs-that-s-what-is-happening <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>In unscripted remarks, the UK Prime Minister revealed his true agenda: he wants to turn our universal health care system into “a fantastic business”. Not patient choice but choice of patient will be the order of the day.</p> </div> </div> </div> <p>In a speech on exports and growth on 10th November 2011, David Cameron went “<span><a class="western" href="http://www.number10.gov.uk/news/prime-ministers-speech-on-exporting-and-growth/">off-script</a></span>” and revealed his government’s true agenda for the NHS. Standing in front of a Union Jack banner and the slogan “START UP BRITAIN” the Prime Minister told his audience of small and medium enterprise people at the BFI on London’s South Bank: “We have a growth review, led by the Chancellor and the business secretary, which ensures that every minister has to come to the table with proposals to cut regulation in their departments and come up with ways of helping business in their sector, helping them to grow.” Then he said: “From the Health Secretary, I don’t just want to know about waiting times. I want to know how we drive the NHS to be a fantastic business for Britain.”</p> <p>He really said that. It’s <span><a class="western" href="http://sturdyblog.wordpress.com/2011/11/10/video-blog-cameron-wants-the-nhs-to-be-a-fantastic-business/">here</a></span> on video: “I want to know how we drive the NHS to be a fantastic business for Britain.”</p><p></p><p>That same week <span><a class="western" href="http://www.telegraph.co.uk/health/healthnews/8880683/Comment-private-takeover-of-Hinchingbrooke-Hospital-is-the-shape-of-things-to-come.html">Hinchingbrooke Hospital became the first NHS Hospital to be franchised</a></span> to a large for profit health care company —&nbsp;Circle.</p><p>The NHS is already big business and some of the costs are there for everyone to see.&nbsp; (Much is hidden). The NHS is haemorrhaging public funds to hundreds of companies through a range of services, legal, accountancy, catering cleaning, PFI and health care.</p> <p>For the last two decades government policy has been to divert billions of pounds of NHS spending to for-profit corporations, including the multi billion pound PFI debt programme. Inflation-proofed PFI payments absorb around 15 per cent&nbsp;of hospitals’ budgets and the figure is rising. No wonder facilities must close, staff are being sacked and patients turned away.&nbsp;</p> <p>These sources of profit have not always existed. Viewing the English NHS and other European health systems as unopened oysters of profitable opportunity, corporations in the USA and Europe have worked long and lobbied hard to open public health care systems to the market.</p> <p>Ten years ago, the United States trade delegation put it like this: “the US is of the view that commercial opportunities exist along the entire spectrum of health and social care facilities, including hospitals, outpatients, clinics, nursing homes, assisted living arrangements, and services provided in the home.”</p><p>Today market predators want more than NHS funds. Claiming, as they have always done, that buying from them will save public money, corporations now want the concession to charge and sell private health care to NHS patients and introduce charges for health care and private health insurance.&nbsp;</p><p>Politicians have offered no answer to the patient protests and ‘save our hospital’ campaigns that commercialization has generated so far. Protest will escalate as the new policy hits home. So, just as Europe’s bankers have got a technocrat to destroy Greece’s public sector, including its national health service, English politicians are distancing themselves from the fall-out from NHS privatizations by vesting responsibility in a hands-off board.&nbsp;</p><p>Commercial interests and right wing ideology lie behind the Health and Social Care Bill (the <span><a class="western" href="http://blogs.ft.com/westminster/2011/10/david-owen-nhs-bill-is-secretary-of-state-abdication-bill/#axzz1eWwOCHDq">“secretary of state Abdication Bill”</a></span> as <span><a class="western" href="http://www.lorddavidowen.co.uk/">David Owen</a></span>, a former health minister, calls it). <span>The Bill abolishes the Secretary of State’s duty to provide comprehensive health care</span> and dismantles the bodies created to deliver it. &nbsp;In their place it introduces the structures and systems of patient and service selection and patient charges. Not patient choice but choice of patient will be the order of the day.</p> <p>All of this is unpacked in a <span><a class="western" href="http://www.healthprofessionals4nhs.co.uk/briefings/">series of briefings</a></span> for the Lords by health professionals.</p> <p>In a two-pronged approach, public health services are transferred from the NHS to local authorities with the functions of both so poorly defined as to bring utter confusion to patients’ and citizens’ rights. The scene is set for a re-run of the transfer in the 1990s of long-term care responsibilities to councils when funding was privatized through means testing and charges. Worse: it’s returning to pre-1948.</p> <p>Not everyone will be covered for all services in the new “NHS”. The government has gone to great lengths to ensure that the newly created commissioners of NHS services (the so-called clinical commissioning groups, CCGs) do not have responsibility for comprehensive care for all residents in <span>one geographical area</span><span>.</span></p> <p>Instead the commissioning groups will able to recruit patients from GP lists across the country. This is not patient choice. It is commissioning groups choosing patients and purchasing what the commissioning groups deem to be the appropriate NHS cover. Selection will be the name of the game.</p> <p>David Nicholson, chief executive of the NHS Commissioning Board, made this absolutely clear when he advised patients to <span><a class="western" href="http://www.bbc.co.uk/news/health-15471034">shop around across the country</a></span> for their GPs based on the range of services offered. (<span><a class="western" href="http://www.healthprofessionals4nhs.co.uk/wp-content/uploads/2011/11/Briefing-Note-Clauses-3-4-6-and-7.pdf">See briefing number 4: clauses 3, 4, 6 &amp; 7</a></span>).</p><p>Clever informed middle class patients may be able to shop around for the best choice of health plans and services, just as some now do for utilities. But there is no guarantee of success, as anyone who tries to navigate electricity, gas, telecom and rail providers know. &nbsp;And try making a complaint! The information is too dense and complex, and the costs too high for the average person to understand what is on offer from complex health care packages.</p> <p>Patient choice is the great con. Patients won’t choose. They will be chosen on the basis of their risk profile. Many of the health care companies now active in the UK manage financial risk by placing time limits on care, introducing cost deductibles, copayments and restrictions on the number of GP visits, hospitals visits, operations. All are commonplace in private health insurance. They are the spectre of what is to come if the Health and Social Care Bill is passed.</p><p>The only hope is the House of Lords.&nbsp; So far peers have signalled general dissatisfaction with ill-specified transfers of fundamental ministerial powers.&nbsp; <span><a class="western" href="http://www.lorddavidowen.co.uk/amended-motion-by-lord-owen-on-the-health-and-social-care-bill/">Lords Owen and Hennessy tabled an amendment</a></span> that made precisely this point and although it was defeated it helped put other peers on notice that forensic examination of the Bill was needed on constitutional grounds.&nbsp;</p><p>With all party agreement on 3rd November&nbsp;the House of Lords agreed that Clause 1, which sets out the duties of the Secretary of State, would be paused and taken off the floor of the house for further deliberation until the Bill returns to the House at the Report stage. It is Clause 1 that severs the duties of the secretary of state to his people to provide and secure comprehensive care. (See our briefing <span><a class="western" href="http://www.healthprofessionals4nhs.co.uk/wp-content/uploads/2011/11/Briefing-Note-a-Clause-11.pdf">here</a></span>).</p> <p><span><a class="western" href="http://www.healthprofessionals4nhs.co.uk/briefings/">Clauses 4, 6, 7, and 10</a></span> give extraordinary discretion to the new corporations with powers to select patients and services.</p> <p>The next few weeks are critical for the Lords.&nbsp; It is up to <a href="http://www.healthprofessionals4nhs.co.uk/"><span>health professionals</span><span> and the medical colleges</span></a> to help them unpack the Bill and follow the amendments as the Lord scrutinize and debate the Bill clause-by-clause through the committee stage. Peers are taking this Bill seriously and giving it the scrutiny that the coalition’s majority prevented in the Commons. &nbsp;</p><p>The NHS will be abolished if the Bill is passed in the Spring. Were that to happen our immediate task would be to draft a short bill to restore it.</p><p><span><a class="western" href="http://www.healthprofessionals4nhs.co.uk/briefings/">The briefings</a></span> show that the structures and functions crucial to protecting our comprehensive health care system are being systematically dismantled. The analysis goes&nbsp;to the heart of what is needed to restore the NHS and it goes to the heart of the government’s lack of candour about the true purpose of its reforms. 

</p><div class="field field-country"> <div class="field-label"> Country or region:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> UK </div> </div> </div> <div class="field field-topics"> <div class="field-label">Topics:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> Civil society </div> <div class="field-item even"> Democracy and government </div> <div class="field-item odd"> Economics </div> <div class="field-item even"> Equality </div> </div> </div> Shinealight uk ShineALight UK Civil society Democracy and government Economics Equality Shine A Light David Price Allyson Pollock Thu, 24 Nov 2011 10:43:51 +0000 Allyson Pollock and David Price 62809 at https://www.opendemocracy.net