Saturday 14 July 2012

2 years ago

2 years ago

Below is an email that I posted on the BMA Council Listserver to fellow BMA Directors, exactly 2 years ago (24 hours following the publication of Andrew Lansley’s White Paper – Equity and Excellence: Liberating the NHS.)

It shows that the White Paper was remarkably clear in its objectives, highlighting Lansley’s intentions to aggressively build on New Labour’s market based NHS. This approach was in total contradiction to the wishes of BMA members, who had repeatedly called for market driven polices to be abandoned. No wonder there was such opposition to the reforms from the medical profession. Unfortunately, much of the major opposition came too late in the day to stop the bill being enacted.

The one key thing the White Paper didn’t make clear at the time was that one of Lansley’s key aims was to make his reforms permanent and entrenched. Hence the need for the enormous amount of legislation contained in the Health and Social Care Bill. This is clearly explained in Nick Timmins’ new book – “Never Again”, which is essential reading and available to download for free here

“Dear All,

I’ve just read the White Paper and my mind is made up. In my opinion, it simply cannot be supported by the BMA because it fundamentally promotes the market based system that our membership has rejected at numerous Annual Representative Meetings.

The rhetoric about devolving power to the frontline professionals doesn’t stand up to scrutiny. It is clear that the autonomy of GP Consortia will be severely curtailed in the name of promoting patient and choice and competition to promote the healthcare market.

The evidence for this is very clear in the White Paper:

1.      Commissioners will be free to buy services from any willing provider; and providers will compete to provide services .
2.      GP consortia will have a high level of freedom; but in return they will be accountable to the NHS Commissioning Board for managing public funds. In future, the NHS Commissioning Board will have a key role in promoting and extending choice and control. The Secretary of State will hold the Commissioning Board to account on delivering improvements in choice and patient involvement, and in maintaining financial control.
3.      GP consortia will align clinical decisions in general practice with the financial consequences of those decisions
4.      One of the functions of the NHS Commissioning board will be to promote personalisation and extend patient choice of what, where and who, including personal health budgets
5.      GP consortia will need to have sufficient freedoms to use resources in ways that achieve the best and most cost-efficient outcomes for patients. Monitor and the NHS Commissioning Board will ensure that commissioning decisions are fair and transparent, and will promote competition.
6.      In General Practice, the Department will seek over time to establish a single contractual and funding model to promote quality improvement, deliver fairness for all practices, support free patient choice, and remove unnecessary barriers to new provision
7.      It has remained the case for several years that just under half of patients recall that their GP has offered them choice. The Department will increase that significantly. We will explore with the profession and patient groups how we can make rapid progress towards this goal
8.      Role of Monitor: Promoting competition, to ensure that competition works effectively in the interests of patients and taxpayers. Like other sectoral regulators, such as OFCOM and OFGEM, Monitor will have concurrent powers with the Office of Fair Trading to apply competition law to prevent anti-competitive behaviour e.g discriminating in favour of incumbent providers
9.      The NHS Outcomes Framework will be translated into a commissioning outcomes framework for GP consortia, to create powerful incentives for effective commissioning
10.  In addition to NHS Choices, a range of third parties will be encouraged to provide information to support patient choice. Our aim is that people should be able to share their records with third parties, such as support groups for patients, who can help patients understand their records and manage their condition better. We will make it simple for a patient to download their record and pass it, in a standard format, to any organisation of their choice

This is everything that the BMA membership wants us to oppose. We simply cannot support it in any shape or form if we take BMA policy seriously. It would make a complete mockery of our campaign. It has far worse potential consequences for the NHS than Working for Patients ever did. This in turn will have profound consequences for the BMA.

Once again, I would like to remind everyone that during the rampant commercialisation of the US healthcare system in the 1980s, "The American medical profession lost public support faster than any other profession" (Blendon R, JAMA)

The only issue for me is what strategy we use to oppose the White Paper.

In view of the above information from the White Paper, do any Council members still seriously believe we should be working with Government to support these policies? If so, then can you please explain how that can be in keeping with BMA policy and the LAON (Look After Our NHS) campaign?

Best wishes,

Thursday 5 July 2012

The NHS: Will you still need me, will you still feed me, when I'm 64?

The NHS: Will you still need me, will you still feed me, when I'm 64?

It is notable that the BBC has reported that patient charging and rationing of care may be needed in the NHS.
Patient charging in the NHS was always part of this Government’s plans. Lansley's NHS reform agenda clearly indicated that new patient charges could be introduced in the next parliament. It looks as though this may happen a bit earlier than planned.
This is all part of the wider NHS privatisation agenda and the grim financial situation the NHS finds itself will accelerate this process. Many NHS campaigners predicted that the number of core NHS services would diminish under the pressure of the £20billion NHS efficiency savings programme, known as QIPP or the Nicholson challenge. This will inevitably lead to increased waiting lists and a new market for healthcare insurance, co-payments and direct patient charges. The idea of the NHS providing a comprehensive service free to all is over. That is why Clause One of the Health and Social Care Bill was so important. The Secretary of State has now abolished his legal responsibility to provide this comprehensive service. Changing this clause was a key denationalisation and privatisation lever. That's what all the fuss was about in the debates. The door to private sector has not only been unlocked, it's been unhinged. As the public interest lawyer, Peter Roderick stated, “the Health and Social Care Bill provides legal basis for charging and a reduction in services
The BMJ reported on this here.

As GP Clinical Commissioning Groups ration care, Foundation Trusts will see their income streams decline. This will be catalysed by competition with other providers who will enter the market through the Any Qualified Provider policy. Foundation Trusts will be forced to generate income by treating more private patients, facilitated by an increase of the private income cap to 49%. Many FTs will still fail financially and either close completely, merge with other FTs, or be taken over by private management.  The NHS hospital sector will therefore continue to shrink. Some care will go into the community and this is where more private takeover will occur, because private community providers will take on some of this work.
The privatisation process will also occur on the GP side. This is already happening in terms of clinical commissioning support services. However, privatisation of GP services is also occurring. The Any Qualified Provider policy is also coming to General Practice as well as the hospital sector.

This still has to be paid for. The private sector isn’t going to offer its services for free! Moreover, shareholders want to see profits to ensure reasonable returns. None of this will be affordable with current funding predictions for the NHS. This means money will need to increasingly come into the system from outside the State. This means insurance, co-pay and direct payment. This places financial risk directly onto the poorest and most vulnerable in society, who will be left will a minimal core service.  This is clearly the end of the NHS and it was clearly predicted. The public has been swindled out of their national health service.

What is really tragic about this is that the NHS is affordable in the long term. Professor John Appleby’s article in the BMJ was particularly enlightening on this topic. Moreover the NHS was founded at a time of huge national debt, far outstripping current levels. Current debt problems are a false argument for decreasing NHS funding. It will only result in personal debts going up as risk is transferred to the poorest.

In addition Billions of pounds are also being wasted on a divisive market system and yet more billions of pounds that could be invested in the NHS are located in tax havens around the world. What we are seeing is an ideological political attack on the NHS and the welfare state.  
In his recent article in the Guardian, Dr Gabriel Scally, who resigned as a DH regional Director of Public Health, got it spot on:
“Financial austerity is being used to dismantle the state”

This is a tragic state of affairs on the 64th birthday of the NHS.