19 May 2011

Health Bill is fatally flawed and must be stopped

The NHS Support Federation have been urging people to make submissions to the NHS Modernisation Listening Exercise. The government has at least “paused” its health plans, but are they willing to see that the health bill is fatally flawed. A health system based on profit-driven competition - where commercial companies can limitlessly take over NHS services - will undermine patient care and the values of the NHS. This idea is not backed by evidence or most of the medical professions and should not be the basis of our health service going forward.

The Federation have designed a letter which can be sent to the chair of the NHS Future Forum, Professor Steve Field. The letter is worth a read as it covers many key concerns. Click on read more to see that. Please also consider sending your own concerns.
Dear Professor Field

I am very concerned by the proposals in the Health and Social Care bill. The NHS Support Federation make many useful points in their submission with which I agree wholeheartedly.

The central idea of the government’s changes is not backed by evidence that it will work. A recent overview of international research concluded that competition in the provision of healthcare can only work in limited areas and brings with it unintended consequences which impact upon quality, value and fairness.[1] Academic studies agree that competition on price - which the bill still allows - will in fact drive down quality.[2] Installing competition right across the NHS and hugely expanding the role of the private sector, in a way that no other country outside the US has tried, is a huge step. The bill does not recognise the dangers and properly protect our health services or patients. Six examples are outlined below.

1) Some patients will be discriminated against as private providers will inevitably seek to select patients that provide the best financial return and refuse to treat the more complex and risky cases.[3]

2) Financial competition will force some hospitals to close[4] - a decision which should be made strategically, not at the whim of the market. The bill enforces the logic of competition that only the fittest should survive. It reduces financial support and effectively allows hospitals to fail before steps are taken to save core services. The bill makes no provision for the loss of non-designated services[5]

3) A recent BMJ article backed the view that the bill is effectively a one-way door to privatisation, as it will force the NHS to follow EU competition rules.[6] Private providers have publicly stated their intention to use the courts to reinforce their right to bid for any area of NHS work.[7] There is therefore no protection against the domination of the private sector in the supply of healthcare to the public. Many would call this privatisation, most would not support it, and there must be a change to the bill to prevent it.

4) Professional bodies have highlighted problems with the standard of care at some private clinics treating NHS patients.[8] However public scrutiny of these companies is shrouded behind commercial confidentiality. Privatisation of the out-of-hours GP service has produced several tragic incidents resulting in the deaths of patients.[9] The regulation and safety of large-scale private sector provision for the NHS patients is at best unproven.

 5) The costs of competition have been massively underestimated. International experience suggests the transaction costs will be substantial[10]. This burden will include not just the cost of the new competition regulator Monitor, but huge spending on lawyers for bids and contracting, as well as fees for accountants, management consultants and on marketing. NHS hospitals and GPs will be increasingly spending public funds on these unnecessary, non patient-related fees. Commissioning already consumes 14% of the English health budget, but expanding competition could force up transaction costs to 30% of all health expenditure – as in the US.[11]

6) The NHS is facing the huge task of finding £20 billion of “efficiency savings”. This unprecedented and difficult task is already raising the pressure on services. Front-line staff numbers are being cut and waiting times are rising. This is quite clearly the wrong time to force further upheaval upon the service. The Public Accounts Committee suggests that the reform plans will detract from the ability of the NHS to deliver such savings.[12]

The bill should protect the values of the NHS not undermine them. It places business motives at the heart of the NHS and passes control in to the hands of commercial companies that will be difficult and expensive to regulate. As the new budget holders, GPs will become “rationers” of care and will likely be compromised by their business interests. The relationship between doctor and patient will change and some trust lost. Services will be more difficult to plan around patients’ needs. Many medical conditions require considerable cooperation between agencies to achieve a high quality of care, but the bill will fragment provision between competing businesses. Quality, value and fairness will all be undermined. The values of the NHS will be eroded and eventually the public’s trust will fail too.

I would strongly urge you to reflect in your report that this flawed plan for market based healthcare is unworkable and that we need a new basis for protecting and improving our NHS.

Yours sincerely

Cllr Philip Booth, Stroud District councillor for Randwick, Whiteshill and Ruscombe ward,
2 The Laurels, Bread Street, Ruscombe, Stroud, GL6 6EL

[1] http://www.bmj.com/content/342/bmj.d2038.full?sid=16f2ca42-c221-4308-8f28-1b1c5671bef1

[2] http://www.efm.bris.ac.uk/ecsb/papers/deaths.pdf -by Carol Propper Bristol University 2002

[3] http://www.lookafterournhs.org.uk/wp-content/uploads/independent-sector-treatment-centres-01062.pdf

[4] http://www.guardian.co.uk/politics/2011/mar/16/health-nhs-reforms-will-shut-hospitals-warning

[5] http://www.capsticks.com/files/library/NHS_Providers_Health_Bill_A4

[6] http://www.bmj.com/content/342/bmj.d2071

[7] House of Commons Health Committee, Commissioning Inquiry, oral evidence, 7 December 2010, questions 482-483

[8] http://www.timesonline.co.uk/tol/life_and_style/health/article6843637.ece

[9] http://www.telegraph.co.uk/health/healthnews/7892044/Companythat-employed-Dr-Daniel-Ubani-cut-corners-for-profit-report.html

[10] Smith P. Market mechanisms and the use of health care resources. In: Achieving better value for money in health care. Directorate for Employment, Labour and Social Affairs, Health Division, 2009.

[11] http://www.bmj.com/content/335/7630/1126.full

[12] House of Commons Public Accounts Committee, National Health Service Landscape Review, Thirty-Third Report, April 2011

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