8 Jul 2011

NHS: must make it to 64th birthday!

So it is now 63 years since the NHS was created. Only 20 MPs have so far pledged to protect the NHS. The moves to introduce competition are a serious mistake - the changes announced by the Government do not go far enough - see here previous comments. Indeed the main thrust of the moves to competition seem to be there with just a few word changes. You can email your MP from this campaign website here.  Please also consider emailing comments to the committee before 14th July: scrutiny@parliament.uk

Here are some of the Green Party's views on approach to health:

Service not a market:
Successive governments have turned the NHS into a market with hospitals and other providers competing against each other. This is wrong and that health care should be a service, not a market. Just as Wales and Scotland have done, we would scrap the market approach to health care returning the focus to service and saving around £5 billion annually.

Local accountability: Local people have little say in their NHS. We need to make the NHS directly accountable to local government. If councillors acted against the interests of local people they can be voted out of office. We also need to ensure that local accountability does not mean a postcode lottery by introducing a requirement for core services and treatments to be provided.

Privatisation: We are opposed to the privatisation of health services.

Prescriptions and dentistry: We need to make these free (which would only cost the government about £3bn). They are essential aspects of health care and charging for them breaks the founding principle of the NHS that it should be free at point of need. Charges prevent some people accessing health care when they need it.

Prevention: more emphasis on prevention.

Up next is an adaptable letter from the NHS Support Federation which I think is a very good summary of issues relating to competition that could go to the Committee. Click on Read more to see.

I would like to submit the following comments on the competition aspects of the health bill.

Even after the government's changes there will be a huge increase in profit-motivated activity in the NHS. Although the timetable has slowed, the policy of “any qualified provider” remains. The policy direction is therefore the same, despite an obvious shift in presentation. “Choice” is in and “competition” is out – now tainted by public disquiet and controversy. Yet the two are inextricably linked in policy terms and it is misleading to suggest  otherwise.

Worryingly, we are advancing competition policy despite the considerable evidence that it will have a negative impact. Only one UK-based study has been cited in support of the government’s plans. Given the level of concern, we need to limit the role of competition in the English NHS until it can be properly evaluated.

Specific issues raised by the competition amendments

1. What protection is there against a Southern Cross style situation? What prevents essential public services being threatened by the way commercial companies choose to run and finance their business? The potential danger of allowing the private sector to control large parts of our healthcare services has not been adequately thought through.

2. It is unrealistic for the government to claim to be able to stop 'cherry-picking'.  Any company trying to maximize its return for shareholders will always seek low-risk, or high-return contracts. How can the government change this fundamental aspect of commercial activity? Its plan to do this through the tariff is untested and complex. The risk of 'cherry-picking' will surely increase with the number of private providers.

3. The government’s stated intention to shift towards integration and away from competition is not reflected in the amendments. The bill is now unclear in the way it sets out the functions it creates. For instance, Monitor will take on the current role of the Cooperation and Competition Panel, but only one of their guiding principles relates to collaboration. The emphasis is still therefore very much weighted towards promoting competition.

4. The government is removing Monitor’s power to specifically open up areas to competition, yet there is no recognition that EU law may force the NHS to allow private sector bidding for contracts. Private providers have made it clear they will pursue this issue into the courts. This was side-stepped by the Future forum, but has been repeatedly raised – notably by independent legal opinion. It should now be properly addressed.

5. The bill should keep in place the limit on the amount of money NHS hospitals can make from private patient income. It is inevitable that removing the cap will lead to NHS staff and beds being used to secure income from private work. It will also raise inequity with richer NHS patients being given the chance to jump the queue.

6. The government has stated that it will block non-tariff competition, where there is no fixed tariff. How will the government ensure the lowest priced provider is not chosen and avoid falling standards in quality. This possibility is not reflected in the amendments to the bill.

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