20 Jul 2010

NHS: more reorganisation and privatisation is not answer

Here is my letter to The Citizen about the recent changes proposed to the NHS. Aggggh! It is all in the wrong direction - more privatisation is not the answer - there is huge amounts of waste......anyway here is what I sent:

Laurence Robertson MP notes the new Government's pledge to ring-fence NHS spending, but this still means cuts in real terms. The Coalition had also promised an end to continuous structural change. However this sixth major reform in 20 years has been described as the 'biggest revolution in the NHS for 60 years'. Plans include an end to 150 primary care trusts and Strategic Health Authorities plus £1bn cuts to management and the loss of thousands of jobs (i).

The Coalitions also plans more damaging deregulation. For example companies which make their money from selling junk food and alcohol will be put in charge of ensuring that people consume less of them. Have you spotted the problem? Allowing business to pay for awareness campaigns instead of forcing them to provide healthier food is a recipe for disaster.

Worse still the crazy market reforms have not ended. The Tories introduced GP fundholding whereby doctors were given power to buy treatment for their patients. It was a failure. Labour abolished it then brought it back as Practice Based Commissioning. It still doesn't work, but now the Coalition are developing it into a complex hugely wasteful compulsory scheme.

Indeed giving control of NHS funds to GPs has been likened to asking your waiter to manage a restaurant. They might know what you want to eat but they won’t necessarily be any good at ordering stock, designing a menu or controlling the chef. Commissioning healthcare is very difficult. Private hospitals are already gearing up to a surge in business as waiting times rise. The NHS will end up simply paying the bills, with guaranteed money flowing into private companies for providing and commissioning NHS services - a nightmare scenario.

The NHS is facing the most difficult financial times in its history. Now is not the time for further massive changes based on a scant evidence base. Patients are not commodities. We need to end privatisation of the NHS and instead move it from a sickness service that diagnoses and treats, into one that also promotes health and pre-empts illness.

Cllr Philip Booth, Stroud District councillor for Randwick, Whiteshill and Ruscombe ward (Green Party)


(i) The Con-Lib coalition document says: "We will stop the top-down reorganisations of the NHS that have got in the way of patient care." Yet less than two months later, Andrew Lansley's white paper is being described as the most radical programme since the inception of the NHS. The white paper goes far beyond the proposals in the coalition document (NHS shakeup, 13 July). This means the coalition document did not state the truth; or the proposals have been cooked up in less than six weeks. If we accept the document was truthful, it means that the most radical reorganisation of the NHS has been "developed" in less than 50 days. And the evidence to back this claim is there. For example, the document says: "The local PCT [primary care trust] will act as a champion for patients and commission those residual services that are best undertaken at a wider level, rather than directly by GPs. It will also take responsibility for improving public health for people in their area, working closely with the local authority." But the white paper reveals that, in fact, PCTs are to be abolished. What possible robustness of planning could there have been in such a short time? Moreover, responsibility for public health will be passed on to councils, just as the public health budget is being almost halved and local government spending has been cut by £1.2bn. Yet issues such as obesity represent the most significant challenges to our future health. Whether one agrees with the coalition agenda of swingeing public spending cuts or not, these plans stand in need of the most rigorous professional scrutiny and the most stringent political critique.


richard.blogger said...

Great post. I've been campaigning against Lansley's plans for a year now. You can find details on my site http://torylies.blogspot.com (I am also on twitter @richardblogger). Here are some notes that will help in your campaign. From the white paper:

“We are very clear that there will be no bail-outs for organisations which overspend public budgets.” (1.22)

“Prices will be calculated on the basis of the most efficient, high quality services rather than average cost.” (5.12)

At the moment hospitals are paid per procedure at a rate that is based on the average cost across England for that procedure. By definition, half of hospitals will do the procedure cheaper and half will do it at higher than cost. NHS hospitals have to re-invest any surplus, but in fact much of surpluses go to pay for deficits that the hospital makes in other services. This cross-subsidy is vitally important.

Lansley’s plan to pay at the cheapest rate means that by definition almost all hospitals will be paid less for the procedure than it costs. This is engineered to make all hospitals go into deficit. (1.22) says that such hospitals will get no government help even though the problems will have been engineered by the government. The only solution other than closure would be the hospital to merge with an organisation with the cash to pay off the deficit – private healthcare. That in effect means that the NHS hospital will no longer exist as an NHS hospital. These plans are simply an effort to close or privatise NHS hospitals.

Philip Booth said...

Thanks for blog comment - agree these changes need to be challenged at every step.