tag:blogger.com,1999:blog-34229311884723872862024-03-19T08:26:53.674+00:00Bevan's RunJanuary 10-15th, 2012. 160 miles in 6 days from Aneurin Bevan's Statue in Cardiff to the Department of Health, Richmond House, Whitehall, London.
To protest against the Health and Social Care Bill and NHS privatisation.
Calling at Witney (David Cameron's constituency).
Follow me on Twitter @cpeedell and #bevansrun.Clive Peedellhttp://www.blogger.com/profile/14800348230625234141noreply@blogger.comBlogger39125tag:blogger.com,1999:blog-3422931188472387286.post-11160302626603587212012-10-04T00:45:00.000+01:002012-10-04T00:45:58.914+01:00What does One Nation Labour mean for the NHS?<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
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<a href="null" name="OLE_LINK18"></a><a href="null" name="OLE_LINK20"></a><a href="null" name="OLE_LINK19"></a><a href="null" name="OLE_LINK13"></a><a href="null" name="OLE_LINK12"><span style="mso-bookmark: OLE_LINK13;"><span style="mso-bookmark: OLE_LINK19;"><span style="mso-bookmark: OLE_LINK20;"><span style="mso-bookmark: OLE_LINK18;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">What does One Nation Labour mean for the NHS?</span></span></span></span></span></a><span style="mso-bookmark: OLE_LINK19;"><span style="mso-bookmark: OLE_LINK20;"><span style="mso-bookmark: OLE_LINK18;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"><br /></span></span></span></span><span style="mso-bookmark: OLE_LINK18;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"><br /><a href="null" name="OLE_LINK15"></a><a href="null" name="OLE_LINK14"><span style="mso-bookmark: OLE_LINK15;"><span style="color: black;">So Ed Milliband has set out his vision for One Nation Labour, which aims to create a fairer society,<span style="mso-spacerun: yes;"> </span>where "those with the broadest shoulders will always bear the greatest burden". One Nation labour has certainly created a lot of positive media attention, but when it comes to the NHS, recent Labour party health policy has been anything but One Nation Labour. In fact, whilst Labour lumbered England with a market driven NHS, Scotland and Wales abolished the purchaser-provider split. Hardly One Nation!<br /><br />So what does One Nation mean for the NHS? Or to put it as BBC political correspondent Nick Robinson stated: "What does it mean in practice?"<br />In his </span></span></a></span></span><a href="http://www.labour.org.uk/ed-miliband-speech-conf-2012?utm_source=taomail&utm_medium=email&utm_campaign=9820+A+game+changer&tmtid=41881-9820-2-2952-83068"><span style="color: black;"><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">speech</span></b></span></span></span><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"></span></span></span></span></a><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"><span style="color: black;">, Mr Miliband made the following statement regarding the NHS:<br /></span><span style="color: black;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">"The NHS, it’s based on a whole different set of values, a whole different set of values that the people of Britain love. Not values of markets, money and exchange but values of compassion, care and co-operation. That is the magic of the NHS; that is why the British people love the NHS and I’m afraid the Tories have shown in government it’s something they just don’t understand."</i></b></span></span></span></span></span></div>
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<span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"><span style="color: black;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><br /></i></b>Mr Miliband clearly criticises the role of the market in healthcare. So if Labour are serious about "rolling back the market"' they need some serious movement away from their New Labour days, which were dominated by the use of markets in public services. This was summarised very well by former Labour cabinet minister John Denham MP in an </span></span></span></span></span><a href="http://www.chartist.org.uk/articles/labourmove/march06denham.htm"><span style="color: black;"><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">article in the Chartist</span></b></span></span></span><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"></span></span></span></span></a><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"><span style="color: black;">,</span></span></b></span></span></span><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"><span style="color: black;"> 2006:<br style="mso-special-character: line-break;" /></span></span></span></span></span></div>
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<span style="color: black;"><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">“All public services have to be based on a diversity of independent providers who compete for business in a market governed by consumer choice. All across Whitehall, any policy option now has to be dressed up as “choice”, “diversity”, and “contestablity”. These are the hallmarks of the “new model public service”</span></i></b></span></span></span></span></div>
<span style="color: black;"><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
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</span></i></b></span></span></span></span><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"><span style="color: black;">In terms of the NHS, New Labour expanded Thatcher's internal market with their own souped up version, using the mutually reinforcing market policies of <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">patient choice, competition between a plurality of Any Willing Provider (AWP), and payment by results (PbR).</i></b><br /><br />The politics of Labour's transformation to New Labour and it’s obsession with markets is very interesting and I have written about it (in relation to NHS changes) in more detail </span></span></span></span></span><a href="http://www.keepournhspublic.com/pdf/Peedell-IAHPEpaper-2009.pdf"><span style="color: black;"><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">here</span></b></span></span></span><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"></span></span></span></span></a><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"><span style="color: black;"> in a paper presented at the International Association of Health Policy in Europe conference in 2009. However, it was summed up brilliantly in one paragraph by 2 Labour MPs, Jon Cruddas and Jon Trickett in the </span></span></span></span></span><a href="http://www.newstatesman.com/uk-politics/2007/12/tories-party-labour-jon-turn"><span style="color: black;"><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">New Statesman</span></b></span></span></span><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"></span></span></span></span></a><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"><span style="color: black;"> in 2007:</span></span></span></span></span><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"><span style="color: black;"></span></span></i></b></span></span></span><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"><span style="color: black;">"After years in opposition and with the political and economic dominance of neoliberalism, New Labour essentially raised the white flag and inverted the principle of social democracy. Society was no longer to be master of the market, but its servant. Labour was to offer a more humane version of Thatcherism, in that the state would be actively used to help people survive as individuals in the global economy - but economic interests would always call all the shots"</span></span></i></b></span></span></span></div>
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<span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"><span style="color: black;"><br /></span></span></i></b></span></span></span><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"><br style="mso-special-character: line-break;" /> </span></span></span></span></div>
<o:p></o:p><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"><span style="color: black;">Tony Blair also explained the realities that Labour faced in a speech to the Chicago stock exchange in 2004:</span></span></span></span></span></div>
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<span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"><span style="color: black;">"Every day, £1 trillion is traded in the foreign exchange markets in the City of London. Any Government that thinks it can go it alone is wrong. If the markets don't like your policies they will punish you".</span></span></i></b></span></span></span></div>
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<span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"><span style="color: black;"><br /></span></span></i></b></span></span></span><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"><br /><span style="color: black;">So what policies do the markets demand? In summary, they demand neoliberal policies and this means:<o:p></o:p></span></span></span></span></span></div>
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<span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"><span style="color: black;">1. Freeing up markets with further deregulation: <o:p></o:p></span></span></span></span></span></div>
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<span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"><span style="color: black;">“<i>I was under, and Britain was under, relentless pressure from the City that we were over-regulating. All through the 10 to 15 years, the battle was not that we regulated too little, but that we regulated too much</i>.”<span style="mso-spacerun: yes;"> </span>Gordon Brown, Telegraph 2011<o:p></o:p></span></span></span></span></span></div>
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<span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"><span style="color: black;">2. “Rolling back the state”. <span style="mso-spacerun: yes;"> </span>Golden rules for public sector borrowing, keeping spending off balance sheets, PFI/PPPs and marketisation and privatisation of public services.<o:p></o:p></span></span></span></span></span></div>
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<span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"><span style="color: black;">3. Supply side economic policies. Low tax, low inflation economies with central bank independence<o:p></o:p></span></span></span></span></span></div>
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<span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"><span style="color: black;">4. Use of private sector management practices in public sector<o:p></o:p></span></span></span></span></span></div>
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<span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"><span style="color: black;">5. TINA – “There is no alternative”. Do as the markets say, or be at the mercy of “Capital flight”<o:p></o:p></span></span></span></span></span></div>
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<span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"><span style="color: black;">The global financial collapse has since changed attitudes towards the neoliberal doctrine, which can be summed up by Newsnight’s BBC Economics editor, <span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">Paul Mason</span>, who wrote in his book<i> </i></span></span></span></span></span><a href="http://www.newstatesman.com/books/2009/04/global-crisis-china-banking"><span style="color: black;"><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><b style="mso-bidi-font-weight: normal;"><i><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">Meltdown. The End of the Age of Greed</span></i></b></span></span></span><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"> </span></b></span></span></span><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"></span></span></span></span></a><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"><span style="color: black;">:<o:p></o:p></span></span></span></span></span></div>
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<span style="color: black;"><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><b style="mso-bidi-font-weight: normal;"><i><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">"A deregulated banking system brought the entire economy of the world to the brink of collapse. It was the product of giant hubris and the untrammelled power of the financial elite.....Basically neoliberalism is over: as an ideology, as an economic model. Get over it and move on. The task of working out what comes after it is urgent . Those who want to impose social justice and sustainability on globalised capitalism have a once-in-a-century chance"</span></i></b></span></span></span><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"><o:p></o:p></span></b></span></span></span></span></div>
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<span style="color: black;"><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-bidi-font-style: italic;">This is probably why Labour is changing its tune and becoming One Nation Labour. It is trying to regain the </span></span></span></span><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"></span></span></span></span><a href="http://www.compassonline.org.uk/news/item.asp?n=1225"><span style="color: black;"><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-bidi-font-style: italic;">soul it lost</span></b></span></span></span><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"></span></span></span></span></a><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-bidi-font-style: italic;"><span style="color: black;"> during the Blair years. However, Labour still faces the same problem that Tony Blair highlighted in his Chicago speech in 2004, except that it is now $3trillion dollars that are traded in foreign exchange markets every day in the City of London!<o:p></o:p></span></span></span></span></span></div>
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<span style="color: black;"><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-bidi-font-style: italic;">I believe that this is why Labour is being very cautious about its policies. In terms of the NHS, they seem muddled. They want to get rid of the market, but leave market structures in place. This makes no sense at all and they need to be pushed on this. If you don’t support markets in healthcare then it is clear that the purchaser provider split needs to be abolished. Yet Andy Burnham is talking about “whole person” tariffs, which smacks of retention of the PP split and use of a more managed market. This is all in keeping with Professor Colin Crouch’s arguments about the </span></span></span></span><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"></span></span></span></span><a href="http://www.timeshighereducation.co.uk/story.asp?storycode=417568"><span style="color: black;"><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-bidi-font-style: italic;">“Strange Non-Death of Neoliberalism”</span></b></span></span></span><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"></span></span></span></span></a><span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-bidi-font-style: italic;"><o:p></o:p></span></span></span></span></div>
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<span style="mso-bookmark: OLE_LINK18;"><span style="mso-bookmark: OLE_LINK14;"><span style="mso-bookmark: OLE_LINK15;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-bidi-font-style: italic;"><span style="color: black;">In summary, I would rather have a National Health Service than a One Nation Health service. Having said that, it is clear that the Labour party are the only party capable of saving of the NHS. They just need a good push in the right direction. <o:p></o:p></span></span></span></span></span></div>
Clive Peedellhttp://www.blogger.com/profile/14800348230625234141noreply@blogger.com5tag:blogger.com,1999:blog-3422931188472387286.post-76599525133468665492012-07-14T00:54:00.003+01:002012-07-14T00:59:20.651+01:002 years ago<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;">
<span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"><strong>2 years ago</strong></span></div>
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<span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">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 – <i style="mso-bidi-font-style: normal;">Equity and Excellence: Liberating the NHS.</i>)</span></div>
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<span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">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.</span></div>
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<span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">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 <a href="http://www.instituteforgovernment.org.uk/publications/learning-lessons-never-again">here</a></span></div>
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<span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">“Dear All,</span><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div>
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<span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">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.</span></div>
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<span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">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.</span></div>
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<span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">The evidence for this is very clear in the White Paper:</span></div>
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">1.</span></i></b><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="color: black; font-size: 7pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"> </span></i></b><span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Commissioners will be free to buy services from <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">any willing provider</i></b>; and providers will <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">compete</i></b> to provide services . </span></div>
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">2.</span></i></b><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-size: 7pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"> </span></i></b><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">GP consortia</span></i></b><span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"> will have a high level of freedom; but in return they will be accountable to the <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">NHS Commissioning Board</i></b> for managing public funds. In future, the <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">NHS Commissioning Board</i></b> will have a key role in <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">promoting and extending choice and control</i></b>. The <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">Secretary of State</i></b> will hold the Commissioning Board to account on <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">delivering improvements in choice</i></b> and patient involvement, and in maintaining financial control.</span><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div>
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">3.</span></i></b><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-size: 7pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"> </span></i></b><span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">GP consortia will align clinical decisions in general practice with the financial consequences of those decisions</span><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div>
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">4.</span></i></b><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-size: 7pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"> </span></i></b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">One of the functions of the <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">NHS Commissioning board</i></b> will be to </span><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">promote personalisation</span></i></b><span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"> and <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">extend patient choice of what, where and who</i></b>, including <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">personal health budgets </i></b></span><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div>
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">5.</span></i></b><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="color: black; font-size: 7pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"> </span></i></b><span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">GP consortia will need to have sufficient freedoms to use resources in ways that achieve the best and most cost-efficient outcomes for patients. <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">Monitor </i></b>and the<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"> NHS Commissioning Board</i></b> will ensure that commissioning decisions are fair and transparent, <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">and will promote competition.</i></b></span></div>
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">6.</span></i></b><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="color: black; font-size: 7pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"> </span></i></b><span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">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, <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">support free patient choice, </i></b>and <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">remove unnecessary barriers to new provision</i></b></span></div>
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">7.</span></i></b><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="color: black; font-size: 7pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"> </span></i></b><span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">It has remained the case for several years that just under half of patients recall that their GP has <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">offered them choice</i></b>. The <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">Department will increase that significantly</i></b>. We will explore with the profession and patient groups <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">how we can make rapid progress</i></b> towards this goal</span></div>
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">8.</span></i></b><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="color: black; font-size: 7pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"> </span></i></b><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Role of Monitor: </span></i></b><b><i style="mso-bidi-font-style: normal;"><span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Promoting competition</span></i></b><span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">, 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 </span><b><i><span style="color: black; font-size: 11.5pt; line-height: 150%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">to apply competition law<sup><span style="mso-text-raise: 5.0pt; position: relative; top: -5pt;"> </span></sup></span></i></b><b><i><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">to prevent anti-competitive behaviour</span></i></b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"> e.g<b><i> </i></b></span><span style="color: black; font-size: 11.5pt; line-height: 150%;">discriminating in favour of incumbent providers</span><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div>
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">9.</span></i></b><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="color: black; font-size: 7pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"> </span></i></b><span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">The NHS Outcomes Framework will be translated into a <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">commissioning outcomes framework for GP consortia</i></b>, to <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">create powerful incentives</i></b> for effective commissioning</span></div>
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">10.</span></i></b><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="color: black; font-size: 7pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"> </span></i></b><span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">In addition to NHS Choices, <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">a range of third parties</i></b> will be encouraged to provide information to <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">support patient choice</i></b>. Our aim is that people should be able to share their records with third parties, such as support</span><span style="color: black; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"> </span><span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">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, <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">to any organisation of their choice</i></b></span></div>
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<span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">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 </span><i><span style="color: black; font-size: 11.5pt; line-height: 150%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Working for Patients</span></i><span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"> ever did. This in turn will have profound consequences for the BMA.</span></div>
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<span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Once again, I would like to remind everyone that during the rampant commercialisation of the US healthcare system in the 1980s, </span><b><i><span style="color: black; font-size: 11.5pt; line-height: 150%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">"The American medical profession lost public support faster than any other profession"</span></i></b><span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"> (Blendon R,</span><i><span style="color: black; font-size: 11.5pt; line-height: 150%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"> JAMA</span></i><span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">)</span><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div>
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<span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">The only issue for me is what strategy we use to oppose the White Paper.</span></div>
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<span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">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?</span><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div>
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<span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Best wishes,</span></div>
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<span style="color: black; font-size: 11.5pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Clive”</span></div>
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<br /></div>Clive Peedellhttp://www.blogger.com/profile/14800348230625234141noreply@blogger.com0tag:blogger.com,1999:blog-3422931188472387286.post-87459169877915018262012-07-05T01:06:00.002+01:002012-07-05T01:12:35.930+01:00The NHS: Will you still need me, will you still feed me, when I'm 64?<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<b style="mso-bidi-font-weight: normal;">The NHS: Will you still need me, will you still feed me, when I'm 64?</b></div>
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It is notable that the BBC has reported that <a href="http://www.bbc.co.uk/news/health-18694119">patient charging and rationing of care may be needed in the NHS</a>.</div>
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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.<br />
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 <a href="http://www.hospitaldr.co.uk/blogs/nhs-consultants-association/for-liberating-the-nhs-read-dismantling-the-nhs">predicted</a> 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, “<a href="http://www.dutytoprovide.net/">the Health and Social Care Bill provides legal basis for charging and a reduction in services</a>”</div>
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The BMJ reported on this <a href="http://www.bmj.com/press-releases/2012/03/08/health-reforms-will-be-end-free-care-all-warn-experts">here</a>. <br />
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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.<br />
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.<br />
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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.</div>
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What is really tragic about this is that the NHS is affordable in the long term. Professor John Appleby’s <a href="http://www.bmj.com/content/343/bmj.d4321.full?ath_user=nhssyatanker001&ath_ttok=%3CTh1vjKMBw1M5kvRdGg%3E">article in the BMJ was particularly enlightening</a> 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.<br />
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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. <span style="mso-spacerun: yes;"> </span><br />
In his <a href="http://www.guardian.co.uk/society/2012/jul/03/financial-austerity-dismantle-state-gabriel-scally?newsfeed=true">recent article in the Guardian</a>, Dr Gabriel Scally, who resigned as a DH regional Director of Public Health, got it spot on:</div>
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">“Financial austerity is being used to dismantle the state” </i></b></div>
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This is a tragic state of affairs on the 64<sup>th</sup> birthday of the NHS.</div>Clive Peedellhttp://www.blogger.com/profile/14800348230625234141noreply@blogger.com1tag:blogger.com,1999:blog-3422931188472387286.post-82282663153016168142012-05-31T18:04:00.002+01:002012-05-31T18:04:26.082+01:00The politics of a bad pensions deal: Doctors and industrial action. Painful, but necessary<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"><strong>Doctors and industrial action. Painful, but necessary</strong></span></div>
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<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">I intensely dislike the idea of doctors taking industrial action over pensions for a number of reasons.</span></div>
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<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">1. It is very hard to take action without harming patient care. Even a cancelled minor operation can cause distress, not only to the patient, but also to relatives who may have to rearrange care arrangements etc.</span></div>
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<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">We should also never underestimate the anxiety people feel before they undergo investigations and treatment. Cancellations add to anxiety and uncertainty.</span></div>
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<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">In addition minor complaints can sometimes be early symptoms of a life threatening illness. If these "minors" are not seen due to cancelled clinics, patients could come to harm. Risks are low, but real. </span></div>
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<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">2. Doctors have been angered by the Government's NHS reforms, which are much more likely to be damaging to patient care in the longer term, than the type of industrial action the BMA is planning (which is not that much different to the service that will be provided over the Jubilee weekend). However, industrial action could take the focus off Lansley's destructive reforms and actually divert bad headlines towards doctors for causing the NHS problems. As an NHS campaigner who has worked hard to expose Lansley's NHS privatisation plans, I am very concerned by this. My priority is to defend the NHS and anything that compromises this is a problem.</span></div>
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<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">3.Many of those who have advocated market based reform of the NHS, have done so on the basis of market theories such as public choice theory, which views public service professionals as "rent seeking knaves" who are only interested in enriching and empowering themselves in monopolistic cartels. Industrial action could actually add weight to these arguments and help the arguments of the NHS pro-marketeers and privatisers. The newspaper headlines are certainly laying it on thick when it comes to “greedy doctors” being more concerned about their pensions than patient care.</span></div>
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<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">4. Economic times are tough and many people are really struggling to make ends meet. We should all be concerned by this because there is clear evidence from the WHO and the work of Sir Michael Marmot and others, that poverty causes ill health and distress. It can disadvantage families for life and the generations that follow. Doctors earn good money in comparison to the average wage. Our pensions also look generous, so this could have significant effects on public sympathy and undermine public trust in doctors. At present, doctors enjoy high public trust ratings, with the <a href="http://www.ipsos-mori.com/Assets/Docs/Polls/Veracity2011.pdf"><span style="mso-bidi-font-size: 12.0pt;"><span style="color: blue;">latest MORI veracity index</span></span></a> showing that doctors are the most trusted people in the country. Trust is also fundamental to the doctor patient relationship. Industrial action could potentially undermine that trust.</span></div>
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<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">However, despite these major concerns, I strongly believe in justice, fairness, the democratic process, as well as economic common sense. Anyone who actually scratches the surface of the pension deal can see that Lansley and the Government are forcing a <a href="http://www.bma.org.uk/images/bmapensionsmediabriefingmay2012-2_tcm41-212763.pdf"><span style="mso-bidi-font-size: 12.0pt;"><span style="color: blue;">very poor deal</span></span></a> on to doctors. Losing a lot of money is clearly an issue to doctors, but it is the unfairness of it all that has really enraged the profession. Doctors are been asked to contribute much more percentage wise to their pensions, than comparable senior public servants. The BMA had already negotiated a long term deal a few years ago too. More details of the unfairness can be seen <a href="http://www.bma.org.uk/employmentandcontracts/pensions/nhs_pensions_reform/iafaqsmay.jsp"><span style="mso-bidi-font-size: 12.0pt;"><span style="color: blue;">here</span></span></a>.</span></div>
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<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Since the BMA is a trade union, it had no choice but to gauge the opinion of its members. The result of a survey showed overwhelming anger from its members and support for a ballot in industrial action. That <a href="http://www.bma.org.uk/employmentandcontracts/pensions/nhs_pensions_reform/index.jsp"><span style="mso-bidi-font-size: 12.0pt;"><span style="color: blue;">ballot has shown</span></span></a> overwhelming support for industrial action. The turnout was 51% and the vast majority supported industrial action. BMA Council were therefore given a clear mandate – TINA.</span></div>
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<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">I couldn't attend the BMA Council meeting when the decision was made to call for industrial action, but as a BMA Council member I fully support the decision of my colleagues to go ahead with it, despite my serious concerns as outlined above. It is vital that the BMA responds to its democratic mandate and tackles this gross unfairness. I've no doubt that doctors will do their best to minimise harm to patients and the BMA will help the profession in this regard. In fact, as previously stated, it is unlikely any action will be much different to the Jubilee bank holiday.</span></div>
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<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">We must get also get the message out to the public that this attack on pensions is a false economy. Increasing pension contributions from doctors and other public service professionals will take yet further demand out of the economy because we will all have less money to spend in our local economies. The private sector clearly needs this demand to expand and help grow the economy. <a href="http://www.youtube.com/watch?v=_r-AKruzmkk&feature=youtube_gdata_player">Paul Krugman clearly articulated</a> this on Wednesday’s edition of BBC Newsnight.</span></div>
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<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">The other key message is that the Government is intent on destroying public sector pensions because it is part of the wider political agenda of replacing large swathes of the public sector with the private sector. The attack on pensions is aimed at softening up the profession for transfer into the private sector. This is because current public sector workers are covered by TUPE legislation and the Fair Deal on pensions, which protects terms and conditions, and pensions respectively. The private sector want cheaper labour to compete in the new healthcare market and to maximise profits.</span></div>
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<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">This is all part of the Government’s supply side economic policy, designed to roll back the state and reduce the taxation burden on big business and the wealthy. They also want further labour market deregulation to increase corporate profits and keep wage inflation and hence general inflation low. </span></div>
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<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">So, in fact, I believe the current fights over pensions are just the start of a much bigger battle which is intrinsically related to privatisation of the public sector. There will more attacks on NHS pensions in the future as the NHS is increasingly privatised and the numbers of employees in the scheme shrinks. This will happen right across the public sector. This is why we need to take a stand now and I am proud that doctors are taking a stand together, just as doctors were the key professional group that campaigned against the Health and Social Care Bill. If we lie down and just take it, they will simply ride roughshod over us every time. This will make it much easier for doctors to be transferred over into the private sector from the NHS. This ensuing marketisation and privatisation of medicine will result in deprofessionalisation and medicine will no longer be an attractive vocation. This will damage patient care in the long term as the doctor-patient relationship will be undermined and fewer of the best and brightest young people opt for a career in medicine.</span></div>
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<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">So it is precisely because we care about patients, that industrial action is necessary. It is a key part of the fight against privatisation and marketisation of the NHS, which will result in inequitable and poorer care in the longer term.</span></div>
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<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">The bottom line is that longer term benefits to patient care by fighting the privatisation agenda far outweigh the small risks of any short term harm to patients through doctors taking industrial action against very unfair pension proposals, which clearly have a much more sinister underlying political motive.</span>Clive Peedellhttp://www.blogger.com/profile/14800348230625234141noreply@blogger.com4tag:blogger.com,1999:blog-3422931188472387286.post-49993227939195628942012-05-15T00:17:00.000+01:002012-05-15T00:18:33.259+01:00Why Lansley is now an asset to the NHS<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<strong>Who cares if Andrew Lansley stays or goes? Either way he is now an asset to the NHS</strong></div>
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As soon as the Health and Social Care Bill became an Act of Parliament, its architect, Andrew Lansley, suddenly became an asset to the NHS. This is because the only hope for the future of the NHS is for the Act to be repealed ASAP. This is only possible if the coalition Government falls at the next election. The way the polls are going, this looks increasingly likely. The latest <a href="http://cdn.yougov.com/cumulus_uploads/document/w0iqjfmpa9/YG-Archives-Pol-Sun-results-140512.pdf">YouGov/Sun poll</a> showed Labour’s highest ever lead since You/Gov polling began in 2002 – a whopping 14%. Of course, things may change, especially if the economy recovers, but with the ongoing Euro crisis this is looking increasingly unlikely. Meanwhile, the Tories are being rebranded as the “nasty party” with a new added twist of “incompetence”, and support for the LibDems has imploded.</div>
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This is the part where Lansley now comes in as an asset to the NHS. He has managed to retoxify the Tories on the NHS and also succeeded in spreading the poison to their LibDem coalition partners. Even senior members of his own party famously said he should be <a href="http://www.bbc.co.uk/news/uk-politics-16930980">“taken out and shot”</a>. His reforms will make the NHS a major issue at the next General Election, probably second only to the economy in importance. He has completely alienated the medical, nursing and other allied health professionals, so the coalition will come in for a kicking on this issue. In fact, he has managed to upset the professions so much that NHS professionals are setting up a new political party to contest coalition MPs (<a href="http://m.bbc.co.uk/news/uk-politics-18062726">See this BBC story</a>). Neither of these pro-marketising and pro-privatising parties will ever be trusted on the NHS again. Their credibility is completely shot.</div>
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It gets worse for the Tories and the coalition too. When it comes to the future of Andrew Lansley as Health Secretary, they are in a lose-lose situation, otherwise known as a win-win situation for NHS supporters. If he remains in post, the coalition’s credibility on the NHS will continue to nosedive, reducing their chances of re-election. If he is sacked in a reshuffle then this would amount to a Government acknowledgement that the Health and Social Care Act is a bad Act. After all, it is Lansley’s baby – he owns it. The Health and Social Care Act is part of the Lansley brand and vice versa. He is the only person in Government that understands it. Rejection of Lansley is a therefore rejection of the Act.</div>
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This is all music to the ears of NHS campaigners because it really doesn’t matter if Lansley stays or goes. He is just as toxic either way. He has truly become a great asset to NHS campaigners fighting for the future of the English NHS.</div>Clive Peedellhttp://www.blogger.com/profile/14800348230625234141noreply@blogger.com0tag:blogger.com,1999:blog-3422931188472387286.post-91638133881526419512012-05-02T23:06:00.000+01:002012-05-02T23:06:03.575+01:00The madness of NHS privatisation<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<b style="mso-bidi-font-weight: normal;">Increasing privatisation of the NHS will wreck our healthcare system</b></div>
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The Health and Social Care Act will clearly lead to increasing privatisation of the NHS. I have explained this in more detail in a <a href="http://www.healthprofessionals4nhs.co.uk/wp-content/uploads/2012/01/Peedell-privatisation-is-inevitable-bmj.d2996.full_.pdf">recent article in the BMJ</a>.</div>
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There are some commentators and think tanks that still deny this is what the Act is about, but this completely ignores the political ideology underpinning the supply side economic policies of the coalition Government, which aim to reduce public expenditure and replace large swathes of public services with private providers. By definition, that is privatisation!</div>
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Other commentators and think tanks believe that the NHS needs more private sector involvement in order to improve its performance. They often base this argument on the following points:</div>
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<li class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-list: l2 level1 lfo3;">The NHS is unaffordable in the long term</li>
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<li class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-list: l2 level1 lfo3;">Privatisation and competition increases efficiency, innovation and responsiveness to patients</li>
<li class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-list: l2 level1 lfo3;">Privatisation is a crucial economic policy to deal with the deficit and TINA</li>
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I believe these arguments are flawed and moreover, there are lots more reasons why NHS privatisation is a really bad idea:</div>
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<b style="mso-bidi-font-weight: normal;">“Much of the NHS is already privatised or relies on private sector”</b></div>
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Those who argue for greater involvement of the private sector in the provision of NHS services frequently highlight the fact that many parts of the NHS already involve the private sector, and in some cases this has been the case since the inception of the NHS.</div>
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<span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">The most frequently cited example is the role of GPs in the NHS as independent private contractors. However, the reality is that GPs are a million miles away from private sector healthcare corporations. Here are just of few of the reasons why:</span></div>
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<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-style: italic; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7pt 'Times New Roman';"> </span></span></span><span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">GPs generally don’t provide any other services outside the NHS</span></div>
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<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-style: italic; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7pt 'Times New Roman';"> </span></span></span><span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">There is no legal duty to maximise profits</span></div>
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<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-style: italic; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7pt 'Times New Roman';"> </span></span></span><span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">GPs build long term relationships with their patients and communities, which is not reducible to commodity values. Patients know this. They don’t consider their GP practices to be “private companies” and have expressed unease at the idea of their health care being provided by people whose primary aim is to make a profit</span></div>
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Another example cited is the role of the pharmaceutical and medical devices industries, where private corporations and market forces contribute to driving innovation and improvement in medical therapies. However, these are global industries functioning in global markets, so the idea that individual Governments should take over this role doesn’t make sense. The arguments against NHS privatisation and marketisation are not about this. The key debate is about how the NHS is organised and structured, and how care is delivered to the population. On this basis there is evidence clear that public funding of private care yields poor results. Professors’ Woolhandler and Himmelstein from Harvard Univeristy <a href="http://www.bmj.com/content/335/7630/1126">stated in the BMJ</a>:</div>
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<b><i><span lang="EN-US" style="mso-ansi-language: EN-US;">“Evidence from the <country-region w:st="on"><place w:st="on">US</place></country-region> is remarkably consistent: Public funding of private care yield poor results”</span></i></b></div>
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<b><span style="mso-bidi-font-style: italic;">“The NHS is unaffordable”</span></b></div>
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<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">All 3 political parties are publicly signed up to a <i>single payer publicly (taxpayer) funded</i> system because there is clear evidence that this is the most cost effective way to fund our healthcare system. Reports confirming this include the Guillebaud report 1951<i>, </i>The Commons Expenditure Committee report 1973, and the<i> </i>Wanless review 2001.</span></div>
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<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">Wanless showed that there had been a £267 billion NHS underspend from 1972-1998 compared to European average spending on health. In his conclusions he stated:</span></div>
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<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">“<i>The surprise may be that the gap in many measured outcomes is not bigger, given the size of the cumulative spending gap</i>” </span></div>
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<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">Although UK spending on health is much nearer the European average, the idea that the NHS is unaffordable does not hold water. A <a href="http://www.bmj.com/content/343/bmj.d4321">recent article in the BMJ</a> by Professor John Appleby, chief economist of the King’s Fund, concluded that spending on the NHS is “a matter of choice, not affordability”. His data briefing graphs are particularly interesting. <span style="mso-spacerun: yes;"> </span></span></div>
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<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">There is also the small matter of the myth about the UK’s current “massive” national debt. Once again, <a href="http://falseeconomy.org.uk/cure/how-big-is-the-problem">the evidence shows the real situation</a>.<b><u></u></b></span></div>
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<b><span style="mso-bidi-font-style: italic;">“The Private Sector is more efficient, innovative and responsive to patients than the public sector”</span></b></div>
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<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">The argument for the private sector being more efficient, innovative and responsive to patients is, by definition, framed in the context of a competitive market system. Market theory maintains that the proper functioning of the market is only possible through competition between private sector organisations with minimal or no government intervention. Hence the need to create a market environment for the private sector to function in the NHS. The key levers of this market system are:</span></div>
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<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">1.</span><span style="font-size: 7pt; mso-bidi-font-style: italic; mso-bidi-font-weight: bold;"> </span><span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">The purchaser-provider split between primary care (Clinical commissioning consortia) and secondary care (Foundation Trusts)</span></div>
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<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">2.</span><span style="font-size: 7pt; mso-bidi-font-style: italic; mso-bidi-font-weight: bold;"> </span><span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">Patient choice </span></div>
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<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">3.</span><span style="font-size: 7pt; mso-bidi-font-style: italic; mso-bidi-font-weight: bold;"> </span><span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">Plurality of providers (Any Qualified Provider - AQP)</span></div>
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<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">4.</span><span style="font-size: 7pt; mso-bidi-font-style: italic; mso-bidi-font-weight: bold;"> </span><span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">Payment by results (PbR)</span></div>
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<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">This system is clearly designed to drive competition between a plurality of providers through the mechanisms of patient choice and money following the patient (or more aptly, the consumer) (PbR). </span></div>
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<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">Unfortunately the market in healthcare throws up all sorts of problems that makes it inefficient, dysfunctional and expensive. Please see 2 of my previous blogs for a more detailed description of the <a href="http://bevansrun.blogspot.co.uk/2012/01/market-failure-in-healthcare-part-1.html">theoretical</a> and <a href="http://bevansrun.blogspot.co.uk/2012/01/market-failure-in-healthcare-part-2.html">practical</a> aspects of market failure in health.</span></div>
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<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">In summary, rather than driving efficiency in the NHS, the problems of market failure inflate healthcare costs by creating excess capacity in the system, driving supplier induced demand, turning patients into consumers of healthcare, and inflating administrative costs of the system due to increased transaction costs and regulatory costs. Private companies also need to cream off profits. This will all inevitably lead to the bankruptcy of the fixed budget of a single payer system. Hence services will become rationed and waiting lists will rise, fuelling the drive towards a mixed funding system through increasing demand for medical insurance, as well out of pocket payments. This fundamentally undermines the founding principles of the NHS, as it cannot be a comprehensive service covering the needs of the whole population. The use of external capital through private insurance to fund care, and the increasing use of private companies delivering and commissioning care, effectively denationalises the system. That is why the Health and Social Care Act abolished <a href="http://www.healthprofessionals4nhs.co.uk/wp-content/uploads/2012/01/How-the-Health-and-Social-Care-Bill-2011-would-end-entitlement-to-comprehensive-health-care-in-England.-Pollock-et-al-Lancet-Jan-26-2012.pdf">the legal basis for the NHS</a> – it was a denationalisation and privatisation Act. </span></div>
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<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">It gets worse. A marketised healthcare system undermines medical professionalism and the doctor patient relationship. As <a href="http://www.psa.org.nz/Libraries/PSA_publications/Reviving_the_Public.sflb.ashx">David Coats from the Work Foundation stated</a> in 2006:</span></div>
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<b><span style="mso-bidi-font-style: italic;">“<i>Relationships between medical professionals and patients depend on trust rather than contractual obligations, and attempting to reduce the provision of healthcare to economic transactions erodes the intrinsic motivations on which the doctor-patient relationships depend</i>” </span></b></div>
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<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">This is exactly what happened in the <country-region w:st="on"><place w:st="on">United States</place></country-region> during the rapid commercialisation of the US Health system in the 1980s. As Blendon stated in the Journal of the American Medical Association</span></div>
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<b><i><span style="mso-spacerun: yes;"> </span>“The American medical profession lost public support faster than any other professional group”.</i><span style="mso-bidi-font-style: italic;"></span></b></div>
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<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">In fact medical professionals are actually an obstacle to market forces, because doctors control access to the healthcare market. Professional bureaucracies are an anathema to the market. Hence there has been an attack on medical professionalism for the last 20 years or so. I was actually politicised by New Labour’s Modernising Medical Careers (MMC) fiasco, which was aimed at producing a “fit for purpose” medical workforce to suit the needs of employers in the new healthcare market. The DH website stated:</span></div>
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<b><span style="mso-bidi-font-style: italic;">“...<i>most importantly, (MMC) will deliver a modern training scheme and career structure that will allow clinical professionals to support real patient choice” </i>(DH Website)</span></b><span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;"></span></div>
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<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">In addition the British Journal of GP editorial on Postgraduate Medical and Education Training Board stated that the Government’s plans for medical education: </span></div>
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<b><i>“…are clearly intended to enable the Secretary of State to direct that standards can be lowered to meet the manpower demands of the NHS.”</i><span style="mso-bidi-font-style: italic;"></span></b></div>
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<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">The focus on “tick box competency based training” rather than professional experiential and tacit knowledge comes straight out of the business school books. The idea is centred on economic principles to make “service lines” as cost effective as possible by using the cheapest possible workers to deliver care to save costs. As long as they have ticked the “competency boxes”, they can do the work. This is all about business principles not who is actually the best person to deliver care to patients.</span></div>
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<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">Thus, privatisation fundamentally undermines professional standards, the doctor-patient relationship and the social contract. This cannot be good for quality of care<b></b></span></div>
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<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">Professor Arnold Relman, former editor of the New England Journal of Medicine, summed up the problems of privatisation and medical professionalism beautifully in a <a href="http://www.rcoklahoma.com/commericialization%20article%20jama.pdf">recent article</a> for JAMA:</span></div>
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<b><span style="mso-bidi-font-style: italic;">“<i>Medical professionalism cannot survive in the current commercialized health care market. The continued privatization of health care and the continued prevalence and intrusion of market forces in the practice of medicine will not only bankrupt the health care system, but also will inevitably undermine the ethical foundations of medical practice and dissolve the moral precepts that have historically defined the medical profession.” </i></span></b></div>
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<b><span style="mso-bidi-font-style: italic;">“Privatisation is crucial to a successful economy” </span></b></div>
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<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">Proponents of supply side economic policies believe that tax cuts, reduced public spending and labour market deregulation are crucial to private sector investment and growth, and hence economic growth. Privatisation through selling off public assets and replacing public sector functions with the private sector, is crucial part of this policy. Labour market deregulation also reduces public expenditure on wages and pensions and also keeps down inflation. In theory, the end result of these policies should be a low tax, low inflation, low interest rate economy, which should lead to increased investment and economic growth. The reality has been very different as evidenced by the global financial crisis.</span></div>
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<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">Privatisation or partial privatisation of the NHS is also a false economy. As explained above, the market system required for the private sector is inefficient, expensive and will bankrupt the single payer system. This will lead to rationing of care, cuts to services and increased waiting lists, resulting in a greater proportion of the population taking out healthcare insurance or making out of pocket payments. This clearly negatively impacts upon the demand side of the economy as people have less money to spend because they have spent it on health cover. In addition, the need for private companies to make profits for their shareholders will result in lower wages for workers and poorer pension deals for new employees who are not protected by TUPE legislation. Once again this negatively impacts on the demand side of the economy and reduces the Keynesian multiplier effect for local economies. This will be a particular problem in the North East, which has a very high percentage of public sector employment. Another problem is that private sector profits often go to offshore tax havens, so yet money is lost from the UK economy.</span></div>
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<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">In contrast, a publicly funded and provided NHS ensures that public money is redistributed around the UK economy because it is a massive employer, which </span></div>
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<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">helps to stimulate our private small and medium sized enterprises, as well larger corporations. So wrecking the NHS through privatisation will not only damage and fragment care, it is also a false economy.</span></div>
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<b><span style="mso-bidi-font-style: italic;">More reasons to reject NHS privatisation</span></b></div>
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<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">Apart from the above arguments, there are plenty of other reasons to reject privatisation of the NHS</span></div>
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<li class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-list: l0 level1 lfo2;"><span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">The Private Finance Initiative. This is a classic example of the failure of a privatisation mechanism. The PFI is essentially an accounting trick designed to allow the building of lots of new hospitals (as well as other public buildings like schools), whilst keeping expenditure off the public sector borrowing sheets. Under New labour, the PFI allowed public debt to be kept below 40%GDP - one of Gordon Brown’s key Golden rules. It also gave fantastic investment returns to the banking sector. The Royal Bank of Scotland did particularly well! Unfortunately the taxpayer will be paying £60billion for £11 billion of hospital buildings</span></li>
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<li class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-list: l0 level1 lfo2;"><span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">Privatisation leads to fragmentation of care and services. The market forces of “creative destruction” will undermine and destabilise key services, which have been built up over decades. The health needs of populations need proper planning, and should not be left to the destructive forces of the market. </span></li>
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<li class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-list: l0 level1 lfo2;"><span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">The Government has said that it is committed to reducing practice variation in order to reduce healthcare expenditure. The DH QIPP team have produced <span style="mso-spacerun: yes;"> </span><i>The NHS Atlas of Variation in Healthcare</i> and stated:</span></li>
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<b><i>“In the recent White Paper, there is a commitment to increasing value from the resources allocated. This requires us to address variations and reduce unwarranted variations in activity and expenditure”</i><span style="mso-bidi-font-style: italic;"></span></b></div>
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<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">Yet privatisation will increase unwarranted practice variation because the citizen-consumerism of a market system caters for “wants” over “needs”. This creates the classic problem of overtreatment as seen in the US healthcare system. The problem of practice variation is further exacerbated by the pro-market policy of abolishing practice boundaries, which undermines population based datasets causing “denominator ambiguity”. This makes it much harder to measure clinical outcomes and practice variation. Commercial confidentiality of private companies further adds to this problem</span></div>
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<li class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-list: l0 level1 lfo2;"><span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">Privatisation also causes dilution of expertise because plurality of provision results in a highly skilled workforce being fragmented as key personnel are transferred from the public sector to the private sector. This will only compound the problems of national shortages of key professional groups like pharmacists and radiographers etc</span></li>
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<li class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-list: l0 level1 lfo2;"><span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">“Privatisation creep”. Once the private sector starts getting contracts with the DH, it becomes increasingly influential in policy making. When New Labour started introducing Independent Sector Treatment Centres, the Commercial Directorate of the Dept of Health had 190 staff, 182 of which were from private sector, with only 8 civil servants. This also links in with the problem of the “revolving doors” culture (see below)</span></li>
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<li class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-list: l0 level1 lfo2;"><span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">Privatisation leads to a “<a href="http://www.againstcorruption.org/BriefingsItem.asp?id=12433">revolving doors</a>” culture between the political class and the private sector. At best this damages the trust in our democratic political system and at worst it results in corruption</span></li>
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<li class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-list: l0 level1 lfo2;"><span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">Privatisation leads to increasing complexity and bureaucracy of the system. This increases costs and also increases opportunities for the private management consultancy industry to offer their expensive advice to the NHS. The classic McKinsey slogan <i>“If you can measure it, you can manage it”</i> is apt. That phrase should also end with the words <i>“and then you can bill for it”.</i></span></li>
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<li class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-list: l0 level1 lfo2;"><span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">Privatisation will lead to increasing legal challenges under competition laws. We have already seen this happen with Virgin, which lost a <a href="http://www.ccpanel.org.uk/content/press-releases/Assura_Press_Release.pdf">recent</a> appeal. Once again this will increase costs to the taxpayer and undermine trust in the system</span></li>
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<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">In summary, it is clear that the arguments in favour of NHS privatisation are flawed and the dangers to our healthcare system from this approach are grave. We must fight this madness or risk losing the nation’s greatest institution.</span></div>
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<b><span style="mso-bidi-font-style: italic;"><span style="mso-tab-count: 1;"> </span></span></b></div>Clive Peedellhttp://www.blogger.com/profile/14800348230625234141noreply@blogger.com11tag:blogger.com,1999:blog-3422931188472387286.post-30338623971617366902012-04-03T00:35:00.002+01:002012-04-03T01:08:45.979+01:0010+ Key reasons why Doctors opposed the Health and Social Care Bill<div class="MsoListParagraph" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; text-indent: -18pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">This list is not exhaustive!</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoListParagraph" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font-family: 'Times New Roman';"> </span></span></span><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">The profession and the public were lied to.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-indent: 36pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Cameron’s speech at 2006 Conservative party conference:</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">“<i>No more pointless and disruptive reorganisations</i>”. Instead, he said that change would be <i>“Driven by the wishes and needs of NHS professionals and patients”</i></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Liberal Democrat MP, Andrew George, of the Health Select Committee, said that Lansley had</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">"<i>Torn up the agreement to resist imposing a top-down re-organisation</i>"</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Thus,<strong><em> trust</em></strong> was destroyed from the off, and it got worse.......</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 18pt;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font-family: 'Times New Roman';"> </span></span></span><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Much of the reform was implemented before the bill was even enacted and then used to justify support for the reforms! Cameron and Lansley repeatedly claimed that the uptake of pathfinder GP Consortia was evidence of widespread support, despite the fact that GPs were desperately trying to fill the hole left behind by the disintegration of PCTs. This was <a href="http://editorsblog.gponline.com/2011/06/09/tough-talking-from-gpc-chairman-leaves-little-room-for-laughs/">perfectly summed up</a> by Dr Laurence Buckman, chair of the BMA GPC who said that:</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt;"><i style="mso-bidi-font-style: normal;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">“</span></i><i style="mso-bidi-font-style: normal;"><span lang="EN-US" style="color: black; font-family: 'Calibri','sans-serif'; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-theme-font: minor-latin;">Getting into the lifeboats is not the same as supporting the sinking of the Titanic.” </span></i><i style="mso-bidi-font-style: normal;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"></span></i></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt;"><br />
</div><div class="MsoListParagraphCxSpLast" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font-family: 'Times New Roman';"> </span></span></span><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">The case for radical change to the NHS was not made. The Government’s arguments were consistently demolished by the evidence.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Doctors accept the NHS is far from perfect, but it is still a highly performing and highly cost effective healthcare system in comparison to other countries. It has recently enjoyed its highest ever public satisfaction rates</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">A good summary of Government myths about the need for change can be found <a href="http://sites.google.com/site/nhsfuture/Home/debunking-the-myths/myth-3">here</a> </span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">There is also <a href="http://www.nhsconfed.org/Publications/Documents/Triumph_of_hope180610.pdf">good evidence</a> that large reorganisations of the NHS have failed to improve the service and are not cost effective </span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: NeueSans-Thin; mso-hansi-theme-font: minor-latin;">The bill seems to fulfil the conclusion that <i style="mso-bidi-font-style: normal;">“reorganisation often seems to be pursued in the absence of good evidence”</i></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 18pt;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-list: Ignore;">4.<span style="font-family: 'Times New Roman';"> </span></span></span><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: NeueSans-Thin; mso-hansi-theme-font: minor-latin;">The legislation will result in increasing marketisation and privatisation of the NHS</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: NeueSans-Thin; mso-hansi-theme-font: minor-latin;">This has been made clear in <a href="http://sites.google.com/site/nhsfuture/Home/debunking-the-myths/myth-4">this explanation</a> by Richard Blogger and also via papers in the BMJ:</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 18pt; mso-add-space: auto; text-indent: 18pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: NeueSans-Thin; mso-hansi-theme-font: minor-latin;"><a href="http://www.healthprofessionals4nhs.co.uk/wp-content/uploads/2012/01/Peedell-privatisation-is-inevitable-bmj.d2996.full_.pdf">Further privatisation is inevitable under proposed NHS reforms</a> </span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 18pt; mso-add-space: auto; text-indent: 18pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: NeueSans-Thin; mso-hansi-theme-font: minor-latin;"><a href="http://www.bmj.com/content/342/bmj.d3760">For profit companies will strip NHS assets under proposed reforms</a></span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: NeueSans-Thin; mso-hansi-theme-font: minor-latin;">BMA policy, which is decided by members at the Annual Representative Meeting (ARM) has shown consistent opposition to NHS privatisation and marketisation</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 18pt; mso-add-space: auto;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-list: Ignore;">5.<span style="font-family: 'Times New Roman';"> </span></span></span><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: NeueSans-Thin; mso-hansi-theme-font: minor-latin;">Doctors believe that competition within the new healthcare market will fragment services, increase inequalities and damage patient care. A MORI poll conducted for the BMA <a href="http://www.bma.org.uk/healthcare_policy/nhs_white_paper/moripoll2011members.jsp">clearly showed this</a> (<a href="http://www.bma.org.uk/images/bmareportmori_tcm41-204420.pdf">Full report</a>)</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: NeueSans-Thin; mso-hansi-theme-font: minor-latin;">Since Lansley’s first guiding principle was to “Maximise competition”, this was clearly at odds with the profession’s view!</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: NeueSans-Thin; mso-hansi-theme-font: minor-latin;">Various Royal Colleges and Medical Societies also made clear statements about the potential for harm to patient care by these reforms eg the <a href="http://www.fph.org.uk/media_centre">Faculty of Public Health stated</a> that:</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt;"><i style="mso-bidi-font-style: normal;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: NeueSans-Thin; mso-hansi-theme-font: minor-latin;">“</span></i><i style="mso-bidi-font-style: normal;"><span lang="EN" style="color: black; font-family: 'Calibri','sans-serif'; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-theme-font: minor-latin;">the Health and Social Care Bill, if passed, would damage the NHS and the health of people in England......we are now calling on the government to withdraw the bill in its entirety because it would be in the best interests of everyone's health”</span></i><i style="mso-bidi-font-style: normal;"><span lang="EN" style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: NeueSans-Thin; mso-hansi-theme-font: minor-latin;"> </span></i><i style="mso-bidi-font-style: normal;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: NeueSans-Thin; mso-hansi-theme-font: minor-latin;"></span></i></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-list: Ignore;">6.<span style="font-family: 'Times New Roman';"> </span></span></span><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: NeueSans-Thin; mso-hansi-theme-font: minor-latin;">The massive reorganisation of the NHS at a time of NHS austerity (ie £20 billion QIPP “savings”) was considered to be an irresponsible act. This was well put by Dr Graham Winyard, who <a href="http://www.guardian.co.uk/commentisfree/2012/mar/06/liberal-democrats-nhs-reforms">resigned from the Liberal Democrats</a> health team because of their support for the reforms:</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt;"><i style="mso-bidi-font-style: normal;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: NeueSans-Thin; mso-hansi-theme-font: minor-latin;">"It is just not sensible to impose this top-down reorganisation on an NHS struggling to meet the biggest financial challenge in its history. To continue to do so in the face of near unanimous opposition from patient, staff and professional organisations simply invites slow-motion disaster both for the NHS and for the party."</span></i></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt;"><br />
</div><div class="MsoListParagraphCxSpLast" style="margin: 0cm 0cm 0pt 36pt; mso-layout-grid-align: none; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-list: Ignore;">7.<span style="font-family: 'Times New Roman';"> </span></span></span><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: NeueSans-Thin; mso-hansi-theme-font: minor-latin;">Market driven medicine leads to deprofessionalisation. In fact, market theory in the form of public choice theory rejects professionalism and the public service ethos. Public servants are viewed as rent seeking knaves. Professor James Buchanan of the Virginia School of public choice theory is on record as saying that the public service ethos does not exist. <span style="mso-spacerun: yes;"> </span>This ideology formed the basis of Julian Le Grand’s influential Knights, Knaves, Pawns and Queens analogy, which led to the rejection of the “Trust” or professional model of healthcare delivery, in favour of the citizen-consumer choice market model. </span><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Times-Roman; mso-hansi-theme-font: minor-latin;">Paradoxically, this view of medical professionals as “rent seeking, knavish” self-interested agents of business, feeds on itself. In the United States, where the commercialisation of medicine exists in its most extreme form, the American medical profession has lost public support faster than any other professional group. (Blendon R. JAMA 1989).</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-layout-grid-align: none;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Times-Roman; mso-hansi-theme-font: minor-latin;">Public choice theory and marketisation of healthcare are key reasons why the medical profession has been under attack for the last 30 years. Doctors are clearly a problem to the proper functioning of the market and must be disempowered. The market clearly cannot function if doctors focus on collaboration rather than competition and build local services through local referral patterns. Professor David Marquand was correct when he stated that public service professionals are “in a profound sense, not just non-market, they are anti-market”. Hence the need to control doctors, which is precisely what the reforms do. Hence GPs were forced into consortia, and the rules of the system mandate that patient choice is paramount. So the idea that clinicians will be empowered is pure folly.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-layout-grid-align: none;"><br />
</div><div class="MsoListParagraph" style="margin: 0cm 0cm 0pt 36pt; mso-layout-grid-align: none; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-list: Ignore;">8.<span style="font-family: 'Times New Roman';"> </span></span></span><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Times-Roman; mso-hansi-theme-font: minor-latin;">Education and Training wasn’t even part of the Bill. In the context of the discussion of public choice theory and markets above, it is not difficult to see why. Medical education and training has been under attack for a long time. New Labour’s introduction of Modernising Medical Careers (MMC) was one of the biggest scandals in medical history. <span style="mso-spacerun: yes;"> </span>It was clearly designed to produce a “fit for purpose” medical workforce to suit the needs of employers in the new healthcare market. </span><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">MMC utilised a competency based tick box approach to training. Competency Based Training (CBT) originated in the 1980s and was a politically driven movement with the aim of making national workforces more competitive in the global markets by focusing on discrete technical skills with an emphasis on outputs, performance assessment, and value for money. Sir John Tooke’s report of MMC, <a href="http://www.mmcinquiry.org.uk/Final_8_Jan_08_MMC_all.pdf">Aspiring to Excellence</a>, clearly highlighted MMC’s emphasis on achieving minimal standards rather than excellence. </span><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Times-Roman; mso-hansi-theme-font: minor-latin;"></span></div><div class="Default" style="margin: 0cm 0cm 0pt 36pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">A prescient editorial in the British Journal of General Practice described how the proposals for MMC: </span></div><div class="MsoListParagraphCxSpFirst" style="margin: 0cm 0cm 0pt 36pt; mso-layout-grid-align: none;"><i><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">“are clearly intended to enable the Secretary of State of the day to direct that standards can be lowered to meet the manpower demands of the NHS”</span></i></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-layout-grid-align: none;"><br />
</div><div class="MsoListParagraphCxSpLast" style="margin: 0cm 0cm 0pt 36pt; mso-layout-grid-align: none; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-list: Ignore;">9.<span style="font-family: 'Times New Roman';"> </span></span></span><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Times-Roman; mso-hansi-theme-font: minor-latin;">The idea that illnesses, diseases and their treatments should be traded as commodities in a market is abhorrent to most doctors in the UK. Most doctors see medicine and the delivery of frontline healthcare as a vocation and a public good, not a hard-nosed business. The idea of profiteering out of a public service is rejected by doctors because it undermines the doctor-patient relationship. This is why the BMA GPC <a href="http://www.gponline.com/News/article/1077930/GPC-chairman-criticises-quality-premium-NHS-privatisation-CQC/">rejected the idea of the Quality Premium</a>, which would result in payments to GPs who hit financial targets.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="margin: 0cm 0cm 0pt 36pt; mso-layout-grid-align: none; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-list: Ignore;">10.<span style="font-family: 'Times New Roman';"> </span></span></span><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Times-Roman; mso-hansi-theme-font: minor-latin;">The bill was driven by ideology, not evidence. This <a href="http://www.andrewlansley.co.uk/newsevent.php?newseventid=21">speech by Andrew Lansley is compulsory reading</a> for all those who want to understand his motivations and ideas. This reform was about replacing the collectivist structure of the NHS with an external market, which will inevitably lead to a mixed funding system. We will see increasing out of pocket costs to patients and increased uptake of healthcare insurance. The <a href="http://allysonpollock.co.uk/administrator/components/com_article/attach/2012-03-08/BMJ_2012_Pollock_HealthSocialCareBill.pdf">legal basis of the founding principles</a> of the NHS has been removed by the Act. The profession did not want this and the public did not vote for it.</span></div><div class="MsoListParagraphCxSpLast" style="margin: 0cm 0cm 0pt 36pt;"></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><br />
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<span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Times-Roman; mso-hansi-theme-font: minor-latin;">Oops! I forgot number 11 (Just like Lansley, Milburn, Clarke and many others over last 20 years) :</span><br />
<span style="font-family: Calibri;">The representative groups of all the major healthcare professions (eg BMA, RCN, RCM) have been excluded from the health policy making process. The exclusion of the BMA is well described in this <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1664062/pdf/bmj00199-0030.pdf">excellent BMJ piece by Professor Rudolph Klein</a>. Politicians prefer to trust the opinions of managment consultants from the likes of McKinsey and KPMG rather than frontline clinical professionals. This is because they share a belief in market driven healthcare. However, this has only served to alienate the health professions from the political class, which has been a disaster for the NHS, because <a href="http://www.leadership.londondeanery.ac.uk/home/links/downloads/Engaging-Doctors-Review.pdf">research has clearly shown that clinical leadership and followership</a> is crucial to any successful healthcare reform. How can this be possible when ideologies are poles apart and trust has completely broken down?</span><br />
<span style="font-family: Calibri;">It is crucial that policy makers and politicians re-engage with the professional representative groups, but this will only be possible if they abandon their unevidenced pro-market ideology. We need to return the NHS to a publicly funded, provided and accountable health system. Anyone who says this is unaffordable should look at the evidence. <a href="http://www.bmj.com/content/343/bmj.d4321">It is a matter of choice, not affordability</a>. It's time to listen to the NHS consultants, not the management consultants. </span><br />
<br />
<span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Times-Roman; mso-hansi-theme-font: minor-latin;">Finally, <a href="http://www.ccjm.org/content/75/Suppl_6/S33.full">a quote from Arnold Relman</a>, Emeritus Professor of Medicine, Harvard Medical School. (Former editor of the New England Journal of Medicine).</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Times-Roman; mso-hansi-theme-font: minor-latin;">This nicely sums up why doctors rejected Lansley’s reforms:</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Times-Roman; mso-hansi-theme-font: minor-latin;">“Medical professionalism cannot survive in the current commercialized health care market. The continued privatization of health care and the continued prevalence and intrusion of market forces in the practice of medicine will not only bankrupt the health care system, but also will inevitably undermine the ethical foundations of medical practice and dissolve the moral precepts that have historically defined the medical profession”.</span></i></b></div>Clive Peedellhttp://www.blogger.com/profile/14800348230625234141noreply@blogger.com2tag:blogger.com,1999:blog-3422931188472387286.post-39618166609363336852012-03-24T00:10:00.000+00:002012-03-24T00:10:06.495+00:00Response to Lord Ashcroft's blog and poll on Conservative Home<div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-theme-font: minor-latin;"><a href="http://conservativehome.blogs.com/platform/2012/03/lord-ashcroft-anti-nhs-bill-candidates-would-boost-the-conservative-party.html">Lord Ashcroft’s blog on ConservativeHome</a></span></b><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-theme-font: minor-latin;"> about doctors standing against coalition MPs at the next election is an interesting read. It relates to <a href="http://www.independent.co.uk/news/uk/politics/doctors-bid-to-unseat-50-mps-in-revenge-over-nhs-bill-7576423.html"><strong><span style="color: purple;">a letter I wrote to the Independent on Sunday</span></strong></a><strong><span style="color: purple;">,</span></strong> which was signed by 250 doctors. The fact that he has written about it and also performed a poll is a clear sign that the coalition Government are worried.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-theme-font: minor-latin;">He concludes from his polling results that doctors standing against Conservative and Liberal Democrat MPs would result in boosting the Conservative party’s electoral fortunes. However, his article and conclusions are flawed in many respects as I discuss below.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-theme-font: minor-latin;">His first key point is about GPs standing on a similar ticket in 1990. He says:</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;"><span style="color: black; font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-theme-font: minor-latin;">“In 1990, a group of GPs established the NHS Supporters Party, with the identical aim of standing 50 parliamentary candidates; the peak of its success was to achieve ninth place in the Mid-Staffordshire by-election of that year, with 102 votes.”</span></i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="color: black; font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-theme-font: minor-latin;">This refers to Kenneth Clarke’s <i style="mso-bidi-font-style: normal;">Working for Patients</i> reforms, which introduced the internal market into the NHS. The BMA launched a major campaign against the reforms, but they did this unilaterally. No other major professional group spoke out. This is very different to the current reforms, where virtually every healthcare professional group came out against the reforms as <b style="mso-bidi-font-weight: normal;"><a href="http://www.whosupportsnhsreforms.org.uk/">illustrated graphically here</a></b>. This level of opposition raised so much concern that the bill was “paused” and more recently, <b style="mso-bidi-font-weight: normal;"><a href="http://conservativehome.blogs.com/thetorydiary/2012/02/the-unnecessary-and-unpopular-nhs-bill-could-cost-the-conservative-party-the-next-election-cameron-m.html">3 cabinet ministers urged Cameron to drop the bill</a></b>. There were even <b style="mso-bidi-font-weight: normal;"><a href="http://politicalscrapbook.net/2012/02/andrew-lansley-shot-rachel-sylvester/">No 10 briefings</a></b> against Andrew Lansley saying he should be “taken out and shot”. Public demonstrations and opposition were also highlighted in the media with the <b style="mso-bidi-font-weight: normal;"><a href="http://www.bbc.co.uk/news/uk-17093082">June Hautot heckling episode</a></b> being the most memorable and damaging. Thus, this is a different level all together. In addition, the GPs in 1990 did not have the weapons of social media that are available now, and the political climate is also very different. Another key point is that Lord Ashcroft’s poll shows that a NHS party would have 18% support. This would be enough to win seats, not merely finish 9<sup>th</sup> place in a by-election. </span><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-theme-font: minor-latin;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-theme-font: minor-latin;">Lord Ashcroft also makes the assumption that our NHS party would stand candidates in marginals and would not get other parties to stand down. He clearly has no understanding of our strategy. In fact our party (which is in the process of being formed) is being advised by an expert in voting theory and the placement of candidates will be considered very carefully indeed. For example, the South West of the country would be an good place to target Liberal Democrats with significant majorities.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-theme-font: minor-latin;">He also extrapolates his poll percentages to an overall electoral result, but if we only field 50 candidates, then we would not see a swing to the Conservatives in the way he describes. In addition, this is not just about taking seats. Even if we don’t take a single seat, we will raise publicity to make the NHS a toxic issue for the Tories and the Liberal Democrats at the next election. They are likely to lose votes even in constituencies we don’t contend. Our repeated message will focus on the undemocratic dismantling, denationalisation and privatisation of the NHS. We will focus on the key messages, which came from the professional associations that stated that the reforms will damage the NHS, fragment care, widen health inequalities, be detrimental to education and training and ultimately harm patient care. <span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-theme-font: minor-latin;">The phrase “No top down reorganisation” will reverberate around the corridors of Conservative Central Office.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-theme-font: minor-latin;">So my own conclusion is that the coalition is rattled by the formation of this new group. We will not be frightened off by Lord Ashcroft’s mistaken claims that we will boost the chances of the Conservative Party being re-elected. We will plan carefully, avoid splitting votes, and try to take as many seats as we can. We don’t fear failure. In fact we are spurred on by the fact that we are in 3<sup>rd</sup> place in Lord Ashcroft’s poll before we have even registered with the electoral commission. We don’t even have a name yet, but one thing is certain, that name will contain at least three letters.... <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">N H S</i></b> </span></div>Clive Peedellhttp://www.blogger.com/profile/14800348230625234141noreply@blogger.com5tag:blogger.com,1999:blog-3422931188472387286.post-14817510499452558472012-03-09T01:29:00.000+00:002012-03-09T01:29:01.540+00:00Speech at TUC Save Our NHS Rally, Westminster Central Hall, 7th March<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;"><a href="" name="OLE_LINK2"></a><a href="" name="OLE_LINK1"><span style="mso-bookmark: OLE_LINK2;"><span style="font-family: 'Arial','sans-serif';">Why did I run 160 miles in 6 days from Cardiff to London with my colleague David Wilson?</span></span></a></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;"><span style="mso-bookmark: OLE_LINK1;"><span style="mso-bookmark: OLE_LINK2;"><span style="font-family: 'Arial','sans-serif';">Because I’m bloody angry about this bill</span></span></span></div><div class="MsoNormal" style="background: white; line-height: 200%; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; line-height: 200%; margin: 0cm 0cm 0pt;"><span style="mso-bookmark: OLE_LINK1;"><span style="mso-bookmark: OLE_LINK2;"><span style="color: #222222; font-family: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">As co-chair of the NHS Consultants' Association, I support Bevan’s idea and vision of an NHS which is comprehensive, equitable and free to all at the point of delivery and<b style="mso-bidi-font-weight: normal;"> <i style="mso-bidi-font-style: normal;">crucially</i></b> an NHS that is publicly funded, provided, and accountable.</span></span></span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;"><span style="mso-bookmark: OLE_LINK1;"><span style="mso-bookmark: OLE_LINK2;"><span style="color: #222222; font-family: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">But this bill fundamentally undermines these principles because it is a denationalisation and privatisation bill that will dismantle the NHS with profound knock-on effects for the social fabric of our nation. </span></span></span><span style="mso-bookmark: OLE_LINK1;"><span style="mso-bookmark: OLE_LINK2;"><span style="font-family: 'Arial','sans-serif';">It will bring back fear to the poorest and most vulnerable in our society.</span></span></span></div><div class="MsoNormal" style="background: white; line-height: 200%; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; line-height: 200%; margin: 0cm 0cm 0pt;"><span style="mso-bookmark: OLE_LINK1;"><span style="mso-bookmark: OLE_LINK2;"><span style="color: #222222; font-family: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">The Government has systematically failed to make the case for its radical reforms at a time when the NHS is performing very well by international comparisons. The bill lacks an evidence base, is hopelessly flawed and is being introduced at a time when the NHS is facing the biggest financial crisis in its history. </span></span></span></div><div class="MsoNormal" style="background: white; line-height: 200%; margin: 0cm 0cm 0pt;"><span style="mso-bookmark: OLE_LINK1;"><span style="mso-bookmark: OLE_LINK2;"><span style="color: #222222; font-family: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">According to Professor Patrick Dunleavy of the LSE, it has all the hallmarks of a “Policy Fiasco” </span></span></span></div><div class="MsoNormal" style="background: white; line-height: 200%; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; line-height: 200%; margin: 0cm 0cm 0pt;"><span style="mso-bookmark: OLE_LINK1;"><span style="mso-bookmark: OLE_LINK2;"><span style="color: #222222; font-family: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">The bill <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">is </i></b>a top down reorganisation and it has <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">no</i></b> democratic mandate.</span></span></span></div><div class="MsoNormal" style="background: white; line-height: 200%; margin: 0cm 0cm 0pt;"><span style="mso-bookmark: OLE_LINK1;"><span style="mso-bookmark: OLE_LINK2;"><span style="color: #222222; font-family: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">It will increase costs and bureaucracy, fragment care and reduce access to care, undermine professionalism and the doctor- patient relationship, the social contract and the public service ethos, and worsen healthcare inequalities and healthcare outcomes.</span></span></span></div><div class="MsoNormal" style="background: white; line-height: 200%; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; line-height: 200%; margin: 0cm 0cm 0pt;"><span style="mso-bookmark: OLE_LINK1;"><span style="mso-bookmark: OLE_LINK2;"><span style="color: #222222; font-family: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Unsurprisingly there is near unanimous opposition to this bill from the major healthcare professional organisations. Even the LibDems own health policydoctors are calling for the bill to be withdrawn. </span></span></span></div><div class="MsoNormal" style="background: white; line-height: 200%; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; line-height: 200%; margin: 0cm 0cm 0pt;"><span style="mso-bookmark: OLE_LINK1;"><span style="mso-bookmark: OLE_LINK2;"><span style="color: #222222; font-family: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Professor Lyndsey Davies, President of the UK Faculty of Public Health said the bill:</span></span></span></div><div class="MsoNormal" style="background: white; line-height: 200%; margin: 0cm 0cm 0pt;"><span style="mso-bookmark: OLE_LINK1;"><span style="mso-bookmark: OLE_LINK2;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="color: #222222; font-family: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">“will damage the NHS and the health of people in England”</span></i></b></span></span><span style="mso-bookmark: OLE_LINK1;"><span style="mso-bookmark: OLE_LINK2;"><span style="color: #222222; font-family: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></span></span></div><div class="MsoNormal" style="background: white; line-height: 200%; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; line-height: 200%; margin: 0cm 0cm 0pt;"><span style="mso-bookmark: OLE_LINK1;"><span style="mso-bookmark: OLE_LINK2;"><span style="color: #222222; font-family: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">In the face of such massive opposition from the very people who are crucial to the success of any NHS reform, the idea that this bill is about to reach Royal Ascent and pass onto the statute book beggars belief.</span></span></span></div><div class="MsoNormal" style="background: white; line-height: 200%; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;"><span style="mso-bookmark: OLE_LINK1;"><span style="mso-bookmark: OLE_LINK2;"><span style="color: #222222; font-family: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">It is a national scandal that MPs and Peers have failed to listen to healthcare professionals and withdraw this bill. The NHS </span></span></span><span style="mso-bookmark: OLE_LINK1;"><span style="mso-bookmark: OLE_LINK2;"><span style="font-family: 'Arial','sans-serif';">is being</span></span></span><span style="mso-bookmark: OLE_LINK1;"><span style="mso-bookmark: OLE_LINK2;"><span style="color: #222222; font-family: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"> disgracefully horse traded for political purposes. </span></span></span><span style="mso-bookmark: OLE_LINK1;"><span style="mso-bookmark: OLE_LINK2;"><span style="font-family: 'Arial','sans-serif';"><span style="mso-spacerun: yes;"> </span>A shameful example of putting the interests of party politics before patients and the public.</span></span></span></div><div class="MsoNormal" style="background: white; line-height: 200%; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; line-height: 200%; margin: 0cm 0cm 0pt;"><span style="mso-bookmark: OLE_LINK1;"><span style="mso-bookmark: OLE_LINK2;"><span style="font-family: 'Arial','sans-serif';">It is vital that the Libdems debate their Emergency motion to withdraw the bill.</span></span></span><span style="mso-bookmark: OLE_LINK1;"><span style="mso-bookmark: OLE_LINK2;"><b><i><span style="color: #222222; font-family: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></i></b></span></span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;"><span style="mso-bookmark: OLE_LINK1;"><span style="mso-bookmark: OLE_LINK2;"><span style="font-family: 'Arial','sans-serif';">So I will be channelling my anger into a 42 mile run from Middlesbrough to Gateshead to try and support the brave LibDems who actually care about the NHS and want to save it for the generations to come.</span></span></span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;"><span style="mso-bookmark: OLE_LINK1;"><span style="mso-bookmark: OLE_LINK2;"><span style="font-family: 'Arial','sans-serif';">But let’s keep fighting and punish those LibDem MPs who support this bill, at the ballot box </span></span></span></div><span style="mso-bookmark: OLE_LINK2;"></span><span style="mso-bookmark: OLE_LINK1;"></span><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;"><br />
</div>Clive Peedellhttp://www.blogger.com/profile/14800348230625234141noreply@blogger.com1tag:blogger.com,1999:blog-3422931188472387286.post-9182031375925590592012-03-04T21:30:00.002+00:002012-03-07T00:29:12.518+00:00Why the NHS reforms won't do what they say on the tin<div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"><strong>Has the case for radical NHS reform been made?</strong></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">A major reason given by the coalition Government to justify the need for radical reform of the NHS is that the demands and expectations of an aging population combined with technological advances in medical care, and a financial crisis, mean that the current model is not sustainable financially.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">The Government also claim the NHS performs badly compared to other nations in terms productivity and efficiency, as well as clinical outcomes.</span></div><div style="margin: 0cm 0cm 0pt;"><br />
</div><div style="margin: 0cm 0cm 0pt;">On the former claim, Professor John Appleby, chief economist from the King’s Fund wrote an interesting data briefing for the BMJ, <a href="http://www.bmj.com/content/343/bmj.d4321"><span style="color: windowtext;"><em><strong>Can we afford the NHS in future</strong></em></span></a><strong>?</strong><span style="mso-spacerun: yes;"> </span>He noted Andrew Lansley’s comments to a <a href="http://www.telegraph.co.uk/health/8551239/Why-the-health-service-needs-surgery.html"><span style="color: windowtext;"><strong>Daily Telegraph article</strong></span></a> <span lang="EN" style="mso-ansi-language: EN;">in June 2011:</span></div><div style="margin: 0cm 0cm 0pt;"><br />
</div><div style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;"><span lang="EN" style="mso-ansi-language: EN;">“If things carry on unchanged, this would mean real terms health spending more than doubling to £230 billion (by 2030)......This is something we simply cannot afford.”</span></i></div><div style="margin: 0cm 0cm 0pt;"><br />
</div><div style="margin: 0cm 0cm 0pt;"><span lang="EN" style="mso-ansi-language: EN;">Appleby commented that this was a short step to an argument that the NHS must change (because unchanged equals unaffordable) and that the change it needs are the Secretary of State’s reforms i.e a version of the “politician’s syllogism”:</span></div><div style="margin: 0cm 0cm 0pt;"><span lang="EN" style="mso-ansi-language: EN;">1. The NHS must change (otherwise it is unaffordable)</span></div><div style="margin: 0cm 0cm 0pt;"><span lang="EN" style="mso-ansi-language: EN;">2. This (the reforms) is change</span></div><div style="margin: 0cm 0cm 0pt;"><span lang="EN" style="mso-ansi-language: EN;">3. Therefore we must do this (the reforms).</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Appleby went on to critique Lansley’s argument and concluded that “</span><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span lang="EN" style="mso-ansi-language: EN;">Spending on health will be a matter of choice, not affordability</span></i></b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">” </span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span lang="EN" style="mso-ansi-language: EN;"><a href="http://t1ber1us.wordpress.com/2012/02/19/what-are-the-nhs-reforms-for/"><span style="color: windowtext;"><strong>Professor Ian Greener’s recent blog</strong></span></a> also laid waste to the Government’s case for change and is essential reading. He noted that the Government approach to policy making is known as a ‘garbage can’ approach in the academic literature ie a solution in search of a problem- not evidence-based policy, but ideologically-driven policy.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Thus the Government are starting from a very weak position if they think radical change to the system is needed.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">So what about the reforms themselves? Do they offer a solution to the fulfilling the long term future healthcare needs of our population, or not?</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">In my opinion, you only have to scratch the surface to see that the proposed NHS reforms will make things worse not better and this is the case from a professional, organisational and economic perspective.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Professional perspectives and effects of the reforms</span></b></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">From a clinical viewpoint, all professional bodies have concerns that the reforms will damage the NHS, fragment care, reduce access to care, increase inequalities, and undermine medical professionalism and the doctor patient relationship. In fact these concerns have hardened more recently, and thus the majority of professional and representative bodies of healthcare professionals are now callinging for the bill to be withdrawn. It therefore really makes you wonder how on earth MPs and Peers can even consider passing this legislation in the face of such professional opposition. The following remarkable statements from clinical leaders only serve to emphasise this:</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Professor Lyndsey Davies, President of the UK Faculty of Public Health (<a href="http://www.fph.org.uk/"><b><span style="color: windowtext; text-decoration: none; text-underline: none;">UKFPH</span></b></a>):</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">“It is clear that the majority of our members now believe that the Health and Social Care Bill, if passed, <b style="mso-bidi-font-weight: normal;">will damage the NHS and the health of people in England</b>”</span></i><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Dr Clare Gerada, Chair of the Royal College of GPs</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">“GPs don’t think the bill is going to create a patient led NHS, they don’t think it is going to increase autonomy, they don’t think it is going to improve patient care, and they don’t think it is going to improve healthcare inequalities”</span></i></b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Crucially, in terms of addressing the needs of an aging population, which is a key Government objective and a reason for reform, this <a href="http://www.bgs.org.uk/index.php?option=com_content&view=article&id=1890:bgs-withdraws-support-for-the-health-and-social-care-bill&catid=6:prindex&Itemid=99"><span style="color: windowtext;"><strong>statement from the British Geriatric Society</strong></span></a> calling for withdrawal of the bill (by it’s President Professor Finbarr C Martin) completely undermines the Government’s argument and credibility:</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">“</span>It has become clear that the proposed legislation is both deeply flawed in detail and deeply troubling in its possible consequences. Our position is informed from the perspective of our members' knowledge and commitment to the health and community services needed by older people. We are concerned that the Bill does not support the changes necessary to provide integrated, high quality consistent care for our ageing population and has a serious risk of undermining the progress made in recent years”</i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span lang="EN" style="mso-ansi-language: EN;">He also states:</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;"><span lang="EN" style="mso-ansi-language: EN;">“The BGS remains committed to work in partnership with all health and social care services to ensure our ageing population receives the best care possible. In our view the provisions in this Bill will be a step backwards in attempts to do this”</span></i></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Thus from a clinical professional perspective, the Government’s reforms will fail to do what they say on the tin.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Organisational perspectives and effects of the reforms</span></b></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span lang="EN" style="mso-ansi-language: EN;">One of the key arguments the Government has put forward to justify the reforms is to cut bureaucracy and save money. However, several respected commentators have highlighted the fact that the bill increases bureaucracy and complexity of the system and will increase costs.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span lang="EN" style="mso-ansi-language: EN;">Professor David Colquhoun has <a href="http://www.dcscience.net/?p=5058"><span style="color: windowtext;"><strong>explained this well in his blog</strong></span></a> and produced some really useful diagrams to show the complexity of the <a href="http://www.dcscience.net/nhs-new.jpg"><span style="color: windowtext;"><strong>new system</strong></span></a> compared to the <a href="http://www.dcscience.net/nhs-prev.jpg"><span style="color: windowtext;"><strong>previous system</strong></span></a>.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span lang="EN" style="mso-ansi-language: EN;">Roy Lilley <a href="http://campaign.r20.constantcontact.com/render?llr=zfxea5cab&v=001e5WobZtxxKQmuBNUc2iBfWLEqJ_rlIvWoQIcyPT2v1ZPJMrgC3DtP8jFK-c_YJte9xSExCP9RWRztxyVqUjLuTO_qBbA8B3PIBa_qWX0G9Ax_JrnTgQXQQ%3D%3D"><strong><span style="color: black;">has also explained</span></strong></a> how 3 layers of management have been replaced by 7 layers.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">This is clearly a major reorganising and restructuring task and the Government estimates of these costs have been challenged by academics including <a href="http://www.bmj.com/content/341/bmj.c3843?sso="><span style="color: windowtext;"><strong>Professor Kieren Walshe</strong></span></a> from the Manchester Business School and <a href="http://blogs.lse.ac.uk/politicsandpolicy/2012/01/24/hsc-bill-policy-fiasco/"><span style="color: windowtext;"><strong>Professor Patrick Dunleavey</strong></span></a> from the LSE</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Current estimates of the reorganisations are around £4 billion compared the Government figure of £1.3 billion.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Walshe states that </span><i style="mso-bidi-font-style: normal;"><span lang="EN" style="mso-ansi-language: EN;">“Little of the current architecture of the NHS will survive these changes unscathed.”</span></i><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span lang="EN" style="mso-ansi-language: EN;">He then offers this advice to the Government:</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;"><span lang="EN" style="mso-ansi-language: EN;">“In brief, the government should learn three things from the history of NHS reorganisation:</span></i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;"><span lang="EN" style="mso-ansi-language: EN;">1.Firstly, structural reorganisations don’t work.</span></i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;"><span lang="EN" style="mso-ansi-language: EN;">2.“reorganisation adversely affects service performance</span></i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;"><span lang="EN" style="mso-ansi-language: EN;">3. the transitional costs of large scale NHS reorganisations are huge”</span></i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Patrick Dunleavey states that the reforms have all the hallmarks of a “<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">policy fiasco</i></b>”.</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Thus from an organisational perspective, the Government’s reforms fail to do what they say on the tin.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="EN" style="mso-ansi-language: EN;">Market based systems and financial perspectives and effects of the reforms</span></b></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">For the NHS market to function there needs to be patient choice to drive competition between a plurality of Any Qualified Providers (AQP). Money then follows the patient through payment by results (PbR).</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Stimulating competition and patient choice is one of the key aims of the bill. Andrew Lansley made what is now <a href="http://www.andrewlansley.co.uk/newsevent.php?newseventid=21"><span style="color: windowtext;"><strong>an infamous speech to the NHS confederation in 2005</strong></span></a>, where he stated that:</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><i style="mso-bidi-font-style: normal;">“</i></span><i style="mso-bidi-font-style: normal;">The first guiding principle is this: maximise competition.... which is the primary objective”</i><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">. </span></i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;">“Competition and choice are not just slogans. They are a policy whose time has come.”</i><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">He went on to describe how this would be achieved - by maximising the numbers of purchasers and providers in the system.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">His method of increasing numbers of purchasers is by getting money closer to the patient (consumer) ie to GPs or patients themselves:</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">“</span>The statutory formula should make clear that choice should be exercised by patients, or as close to the patient as possible, thereby maximising the number of purchasers and enhancing the prospects of competition, innovation and responsiveness to patients”</i><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">This is why his reforms are placing £60 billion of the NHS budget in the hands of “GP led” Clinical Commissioning Groups and why the policy of patient held budgets is being expanded. </span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">In terms of maximising the numbers of providers, this will be achieved through the Any Qualified Provider (AQP) policy, where private companies and third sector (non profit) organisations are encouraged to enter the new market. </span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">This creation of excess capacity in the system is the only way for patient choice and the market to function, which is confirmed by Lansley himself:</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">“T</span>he reforms I describe are designed to stimulate a significant capacity response”</i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">However, having excess capacity is inherently inefficient, especially in a single payer system where there is a finite amount of money. Also very worrying is the drive to promote citizen–consumerism in healthcare, where patients act like consumers in a marketplace and shop around for health services. This is a system that responds to <i style="mso-bidi-font-style: normal;">wants</i> rather than <i style="mso-bidi-font-style: normal;">needs</i>, and is a recipe for inflating healthcare expenditure and creating inefficiencies through overtreatment and undertreatment. <span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">So the slogan <i style="mso-bidi-font-style: normal;">“No decision about me without me”</i> is really about the idea of citizen- consumerism and increasing consumer power in the new healthcare market.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">This clearly has highly significant cost implications for a single payer system.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">If we now factor in the transaction costs of the market, it becomes apparent that it is highly unlikely that the single payer system can survive. This <a href="http://www.bmj.com/content/335/7630/1126"><span style="color: windowtext;"><strong>important paper in the BMJ</strong></span></a>, shows how the market has inflated costs in the US system. Moreover, in the UK, research from Karen Bloor of York University, which was cited by the Health Select Committee’s report on Commissioning in 2009, has estimated that administrative costs of the NHS following the introduction of the internal market reached about 15% of total NHS budget versus ~5% prior to the purchaser-provider split. The new market may reach higher percentages as the number of market transactions will increase and the need for private commissioning support through the Framework for External Support for Commissioning (FESC) is encouraged.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Thus from a financial perspective, the Government’s reforms will fail to do what they say on the tin.</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">In fact the reforms will. <span style="mso-spacerun: yes;"> </span>Coupled with increased costs associated with the reforms, the system will break under the pressure.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Future perspectives and effects of the reforms on creating a mixed funding system</span></b></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">The new market system will increase healthcare expenditure and force the NHS into financial meltdown. <span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">This will be catalysed by the McKinsey £20 billion<strong> </strong><a href="http://www.dh.gov.uk/en/Healthcare/Qualityandproductivity/QIPP/index.htm"><strong>QIPP</strong></a> efficiency drive, which amounts to a 4% per year efficiency saving until 2015. This scale of savings has not been attempted in any healthcare system in the world and it will lead to the demise of the single payer system, which <a href="http://www.telegraph.co.uk/news/uknews/1363664/Tax-funded-NHS-offers-fairest-and-best-value-way-ahead.html"><strong>Derek Wanless concluded was the most cost efficient way</strong></a> to fund the NHS. </span>This then opens the door to a mixed funding system <span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">with increasing use of private insurance, user fees and top up payments.</span></div><div style="margin: 0cm 0cm 0pt;">And this is where we come to the heart of it - the reforms will makes this transition happen in the following ways:</div><div style="margin: 0cm 0cm 0pt;"><br />
</div><div style="margin: 0cm 0cm 0pt;">• Firstly, Clinical commissioning groups will increasingly becoming rationing bodies, driving up waiting lists and reducing the number of NHS core services. Thus there will be an <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">increasing demand for healthcare insurance</i></b> as waiting lists go up. The QIPP efficiency measures will act as a catalyst to this process;</div>• Secondly, Foundation Trusts <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">can borrow money from the City</i></b> to invest. They will have to repay this by treating more NHS patients and more private patients. This will be aided by the raising the cap on private patients’ income for FTs to 49%. However, financial pressures will drive foundation Trusts into further debt burdens forcing closures, mergers and private management takeovers. This is already happening. In fact, this whole process is crucial to <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">stimulating the private healthcare insurance and private provider industry.</i></b><br />
• Thirdly, there will be <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">a new insurance market set up for top ups and co-payments</i></b>; and<br />
• Fourthly, in the next Parliament, it is likely that more <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">direct patient charges</i></b> will be introduced.<br />
A failure of the NHS to provide a comprehensive service and the move towards opening up a mixed funding system requires the Secretary of State to abdicate his/her duties and powers to provide a comprehensive healthcare service to the nation’s population. This effectively denationalises the NHS and explains why the Government will not back down on Clause 1 and related clauses, which have been hotly debated in the Lords. They need to abolish these clauses to <a href="http://www.healthprofessionals4nhs.co.uk/wp-content/uploads/2012/01/How-the-Health-and-Social-Care-Bill-2011-would-end-entitlement-to-comprehensive-health-care-in-England.-Pollock-et-al-Lancet-Jan-26-2012.pdf"><strong>abolish the NHS</strong></a> and create the mixed funding systems. The work of Peter Roderick, Allyson Pollock and others is an essential read to understand this in more detail. I therefore strongly recommend the <a href="http://www.dutytoprovide.net/"><span style="color: windowtext;"><strong>Duty to Provide website</strong></span></a>.<br />
English citizens will increasingly have to consider taking out healthcare insurance policies as financial pressures cause the NHS to fail. Healthcare rationing by CCGs, Rising waiting lists, and reduction in NHS core services will fuel the insurance industry’s engine. This clearly has the most adverse effect on the most vulnerable in society because of the <a href="http://www.sochealth.co.uk/history/inversecare.htm"><span style="color: windowtext;"><strong>Inverse Care Law </strong></span></a>.<br />
Finally, opening up the NHS to<strong> </strong><a href="http://www.leftfootforward.org/2011/03/tory-nhs-reforms-european-competition-law/"><span style="color: windowtext;"><strong>EU competition law </strong></span></a>will dramatically increase the amount of capital available to bring into our health service, but ultimately this capital will flow back to the investors at a profit, which will be at the expense of the UK citizens as taxpayers and in the form of private healthcare insurance premiums and out of pocket healthcare expenditure.<br />
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<b style="mso-bidi-font-weight: normal;">Conclusion: The politics and false economy of the reforms</b><br />
The Government’s reasons for radical reform of the NHS are flawed, lacking in evidence, and driven by ideology. Their solutions will actually create more problems by increasing healthcare costs and bankrupting the NHS, leading to a mixed funding system of healthcare, with increasing marketisation and privatisation. Of course, increasing privatisation is a key supply side economic policy of the Government, which they are applying right across the public sector. New Labour were doing similar things, but not in such a drastic manner. I have discussed the politics of this neoliberal approach in <a href="http://bevansrun.blogspot.com/2012/01/politics-of-nhs-market-reforms.html"><strong><span style="color: black;">another blog</span></strong></a>. The basic premise is that privatisation of public services will reduce the tax burden on corporations, reduce inflation and stimulate economic growth. However, the drive towards privatisation and a mixed funding system will increase economic and healthcare inequalities, which are both known to damage economic growth, which in turn impacts heavily upon the social determinants of health, causing a viscous circle of greater inequality. This is in direct contradiction to Clause 3 – the new duty of the Secretary of State for Health to reduce health inequalities.<br />
The reforms will be economically damaging for a number of reasons. Citizens will have less money in their pockets as they have to pay for increasing proportions of their healthcare costs. Thus they will have less money to spend in their local economies. In addition, private companies will reduce terms and conditions for health workers who will have less money to spend in their local economies. These companies will also siphon off taxpayers money into their profit margins, the meteoric pay packets of their CEOs, and offshore tax havens. This will all be damaging the UK economy and thus NHS privatisation is a false economy.<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">We are about to lose our greatest institution, which is a highly performing and popular healthcare system. The NHS not only delivers on access, equity and fairness, but also acts to redistribute wealth around the country and stimulate local economies through the multiplier effect, helping local private businesses to grow and help stimulate the overall economy. Let’s not lose it to an ideologically driven coalition government, who have absolutely no democratic mandate to dismantle it. <span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div>Clive Peedellhttp://www.blogger.com/profile/14800348230625234141noreply@blogger.com1tag:blogger.com,1999:blog-3422931188472387286.post-70539933008358684852012-02-29T01:38:00.002+00:002012-02-29T07:49:08.068+00:00Holding the Liberal Democrats to account at their Spring Conference.<span style="font-family: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span><br />
<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span lang="EN-US" style="font-family: 'Arial','sans-serif'; mso-ansi-language: EN-US;">“There can never be a better time for a Beveridge”</span></i></b><br />
<br />
</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Despite widespread opposition to the bill <a href="http://www.nhscampaign.org/NHS-reforms/size-matters.html"><span style="color: windowtext;">from nearly all NHS stakeholders </span></a>, the Liberal Democrats are still propping up the Health and Social Care Bill. Considering the following public statements from leading professional bodies, this political postitioning is nothing short of disgraceful.</span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Professor Terence Stephenson, President of the Royal College of Paediatrics and Child Health (<a href="http://www.rcpch.ac.uk/news/rcpch-votes-government-withdraw-health-and-social-care-bill"><span style="color: windowtext;"><strong>RCPCH</strong></span></a>):</span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">“It is clear that a substantial majority of our voting members believe that the Health and Social Care Bill carries risk for children and young people”</span></i></b></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">This message was echoed by <a href="http://download.thelancet.com/mmcs/journals/lancet/PIIS0140673612602700/mmc1.pdf">154 prominent paediatricians</a> in a <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60270-0/fulltext?version=printerFriendly">letter to the Lancet</a>, which stated:</span></div><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"><span style="font-family: Times New Roman; font-size: small;"></span></span><br />
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</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Professor Lyndsey Davies, President of the UK Faculty of Public Health (<a href="http://www.fph.org.uk/"><span style="color: windowtext;"><strong>UKFPH</strong></span></a>):</span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">“It is clear that the majority of our members now believe that the Health and Social Care Bill, if passed, will damage the NHS and the health of people in England”</span></i></b></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Professor Finbarr C Martin, President, British Geriatrics Society (<a href="http://www.bgs.org.uk/index.php?option=com_content&view=article&id=1890:bgs-withdraws-support-for-the-health-and-social-care-bill&catid=6:prindex&Itemid=99"><span style="color: windowtext;"><strong>BGS</strong></span></a>)</span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">“We are concerned that the Bill does not support the changes necessary to provide integrated, high quality consistent care for our ageing population and has a serious risk of undermining the progress made in recent years”</span></i></b></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 10pt;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Dr Clare Gerada, Chair of the Royal College of GPs</span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">“GPs don’t think the bill is going to create a patient led NHS, they don’t think it is going to increase autonomy, they don’t think it is going to improve patient care, and they don’t think it is going to improve healthcare inequalities”</span></i></b></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 10pt;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 10pt;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">It is clear that professional bodies think that the bill will damage the NHS and harm patient care. It is therefore simply unacceptable that politicians continue to support this bill. They are clearly putting politics before patients. Even Baroness Williams has damaged her own reputation on the NHS. She is a friend of the NHS no longer. </span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 10pt;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">However, it is somewhat reassuring that at least some grassroots Liberal Democrats are calling on their party to withdraw their support for the Health and Social Care Bill. <a href="http://www.charleswest.org/"><span style="color: windowtext;">Dr Charles West</span></a>, a GP and Liberal Democrat for Shrewsbury and Atcham, has launched a petition for this purpose, and has also put an important <a href="http://www.shropshirelive.com/2011/09/07/shropshire-doctor-takes-the-fight-for-the-nhs-back-to-lib-dem-conference/">emergency motion</a> on the Health Bill forward for debate at the Liberal Democrat Spring Conference.</span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 10pt;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">The Liberal Democrats have a proud heritage of supporting public services and social welfare through state intervention. This is very much based on the work of famous Liberals like William Beveridge and John Maynard Keynes. However, more recently, the Liberal Democrat Party has been consumed by the free-market neoliberal ideology of Orange Book liberals, who include Nick Clegg, Vince Cable and David Laws. I thoroughly recommend <a href="http://www.theliberal.co.uk/libdems/neo-liberal-democrats.html"><span style="color: windowtext;"><strong>this article by Simon Kovar</strong></span></a>, which goes into some detail on this subject. Some of their philosophy marries very well modern conservatism, and the fact they formed a coalition Government with the Conservatives is not surprising in the slightest. This is an excellent and prescient article from <a href="http://www.tribunemagazine.co.uk/2010/05/how-the-orange-bookers-took-over-the-lib-dems/"><span style="color: windowtext;"><strong>Tribune magazine</strong></span></a> on this topic.<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 10pt;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">The centre left of the party, which represents the majority of grassroots LibDems has been decimated by the centre right Orange Bookers. The Liberal Democrat attack on the NHS is therefore completely understandable in political terms. The Orange Book, which was published in 2004 notoriously called for a social insurance system, with private providers to replace public provision of NHS care. I’ve described this previously in some more detail in this <a href="http://www.hospitaldr.co.uk/blogs/nhs-consultants-association/why-are-the-lib-dems-betraying-the-nhs"><span style="color: windowtext;"><strong>Hospital Doctor blog </strong></span></a></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Tellingly, a younger Nick Clegg in 2005 was <a href="http://gimpyblog.posterous.com/what-happened-to-the-independent-profile-of-n"><span style="color: windowtext;"><strong>quoted in the Independent</strong></span></a> as saying</span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><b><i style="mso-bidi-font-style: normal;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">"One very, very important point - I think breaking up the NHS is exactly what you do need to do to make it a more responsive service."</span></i></b><i style="mso-bidi-font-style: normal;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></i></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">On a more positive note, the progressive wing of the Liberal Democrats has reformed the Beveridge Group . Their <a href="http://www.beveridgegroup.org.uk/"><strong>website states</strong></a> that:</span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">“</span></i></b><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span lang="EN-US" style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-ansi-language: EN-US;">The revival of the Beveridge Group has been stimulated by a growing awareness that there is no fundamental debate about the role of public services within the coalition”</span></i></b><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"></span></i></b></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 10pt;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 10pt;"><span lang="EN-US" style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-ansi-language: EN-US;">Key members include Tim Farron (President of the LibDems), Andrew George, John Pugh, Simon Hughes, Norman Baker and Alistair Carmichael.</span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 10pt;"><span lang="EN-US" style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-ansi-language: EN-US;">It is therefore of vital importance for the NHS that this group sticks to its longstanding and proud principles and protects the NHS by coming out against the bill. Andrew George has done this already and Tim Farron has been critical of the bill. However, the group needs to have the courage to go further. The Conference must support Dr Charles West’s motion and not water it down.</span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 10pt;"><span lang="EN-US" style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-ansi-language: EN-US;">The “Bevan-Beveridge Run” aims to raise awareness of the dangers of the bill and simulate debate with the Liberal Democrat ranks about where their loyalties lie. Do they support the NHS or do they support it’s destruction by the Orange Bookers? It’s time to decide</span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 10pt;"><span lang="EN-US" style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-ansi-language: EN-US;">In our view:</span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 10pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span lang="EN-US" style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-ansi-language: EN-US;">“There can never be a better time for a Beveridge”</span></i></b></div><br />
<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"><em><strong></strong></em></span><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><br />
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<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 10pt;"></div>Clive Peedellhttp://www.blogger.com/profile/14800348230625234141noreply@blogger.com0tag:blogger.com,1999:blog-3422931188472387286.post-91149478206638355362012-02-29T01:15:00.003+00:002012-02-29T07:30:52.576+00:00Bevan's Run 2 - "The Bevan-Beveridge run"<div class="MsoNormal" style="line-height: normal; margin: 12pt 0cm 0pt;"><strong><em><span style="font-family: 'Arial','sans-serif';">Middlesbrough to Newcastle, 42 miles in under 17hours, March 9th-10th, 2012</span><span style="font-family: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></em></strong></div><br />
<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">On Friday 9<sup>th</sup> of March, Dr David Wilson and myself will be heading off on another long distance run to continue our protests against the Health and Social Care Bill. This time we are aiming our protest at the <strong>Liberal Democrat Spring Conference</strong> in Newcastle, by running 42 miles in under 17 hours (Middlesbrough to Newcastle).</span><br />
<div class="MsoNormal" style="line-height: normal; margin: 12pt 0cm 0pt;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">We will be starting our run at approximately 6pm outside our place of work, James Cook University Hospital, in Middlesbrough. We will be running to Durham, where we will bed down for a few hours, before getting up and starting the second leg at 7am to head to Wesley Square, Newcastle, to join the <a href="http://www.keepournhspublic.com/meeting.php?id=350">Keep Our NHS Public rally</a> at 11am. There will then be a march to Baltic Square, Gateshead for a 12.30pm demo against the LibDems involvement in the dismantling of the NHS.</span></div><div class="MsoNormal" style="line-height: normal; margin: 12pt 0cm 0pt;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Details of the rally are </span><b style="mso-bidi-font-weight: normal;"><span style="font-family: 'Arial','sans-serif'; font-size: 12pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"><a href="http://www.keepournhspublic.com/meeting.php?id=350">HERE</a></span></b><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">, so please come along to demonstrate against the NHS reforms <span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></div>Clive Peedellhttp://www.blogger.com/profile/14800348230625234141noreply@blogger.com1tag:blogger.com,1999:blog-3422931188472387286.post-90806575481572566972012-02-18T18:52:00.002+00:002012-02-18T18:52:38.127+00:00Royal College of Radiologists Extraordinary General Meeting<div class="MsoNormal" style="background: white; margin: 0cm 0cm 12pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 18pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">RCR EGM 16th February 2012</span><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"><br />
<br />
I made following speech at the RCR EGM to support the motion below.<br />
The motion was supported in full. The full results can be found <a href="http://www.rcr.ac.uk/docs/about/pdf/Post_EGM_16212.pdf"><span style="color: #2288bb; text-decoration: none; text-underline: none;">here</span></a>.<br />
(Please note the number of abstentions for the Council's own motion)</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><b><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">That this meeting:</span></b><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><b><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">(a) welcomes the RCR statement that it cannot support, and must continue to oppose the passage of the Health and Social Care Bill in its current form;</span></b><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><b><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">(b) considers that the Health and Social Care Bill, if passed, will damage the NHS and widen healthcare inequalities, with detrimental effects on patient care in England;</span></b><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><b><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">(c) cannot support the Health and Social Care Bill without seeing the NHS reform Risk Register<br />
(d) calls upon the RCR to publicly call for withdrawal of the Health and Social Care Bill;<br />
(e) calls upon the RCR to seek an alliance with the BMA, RCN, RCM and other willing Royal Colleges and NHS stakeholder organisations to collectively call for the withdrawal of the Health and Social Care Bill.</span></b><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><b><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">(f) calls upon the RCR to hold a joint press conference with the BMA and other willing Royal Colleges and NHS stakeholder organisations, to make a joint public statement calling for the bill to be withdrawn</span></b><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 12pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"><br />
<b><u>Speech</u></b></span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">"I would like to thank Council and the President for calling this important meeting</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">I am co-chair of the NHS Consultants’ Association, a member of BMA Council and the Political Board.</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">This is not a party political issue. I campaigned against New Labour’s market based NHS reforms because I believe that a publicly funded, publicly provided, and publically accountable NHS is the most cost effective and equitable way of delivering healthcare to our population.</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">This is about defending the NHS from increasing marketisation and privatisation, which will inevitably undermine the founding principles of the NHS, leading to increasing healthcare inequalities, reduced access to care, increased healthcare expenditure, and the undermining of medical professionalism and the doctor-patient relationship</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">I don’t accept and I don’t think anyone accepts the status quo. I think we all realise that the NHS has problems and we would all agree that the NHS needs to continuously adapt, change and improve to meet the current and future health needs of the nation. But this has always been the case and will continue to be so. It is part of the duty of being a doctor.</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">However, we will hear today why the Health and Social Care Bill is not the answer to the problems of the NHS and will in fact make things worse not better. We’ll also hear why the case for such a radical change to the NHS has not been made. </span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Not only is the bill 3 times longer than the original bill and littered with 100s of new amendments, there is widespread recognition that something is deeply wrong with this bill. The level of opposition is unprecedented and ranges from the usual suspects of the unions, right through to members of the Cabinet of the Government. There are at least 23 professional groups in opposition including frontline staff as well as NHS managers. The highly critical joint editorial from the BMJ, HSJ and Nursing Times was a watershed moment.</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Surveys of the RCGP have shown that the vast majority want the bill withdrawn.</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Clare Gerada has stated:</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">“GPs don’t think the bill is going to create a patient led NHS, they don’t think it is going to increase autonomy, they don’t think it is going to improve patient care, and they don’t think it is going to improve healthcare inequalities”</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Professor Lyndsey Davies, Chair of the UK FPH, which has just publicly called for withdrawal of the bill, has <a href="http://www.fph.org.uk/"><span style="color: #2288bb; text-decoration: none; text-underline: none;">stated</span></a> that: “the majority of our members now believe that the Health and Social Care Bill, if passed, will damage the NHS and the health of people in England”</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">There is also great confusion about what the bill actually means. Hamish Meldrum said it was “Hopelessly complex”. The new Chair of the NHSCB, Professor Malcolm Grant, who is a lawyer, said it was “unintelligible”.</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">However, experts in constitutional, public and commercial law, as well as health policy have written extensively about the bill and published their analyses in major medical journals to explain what the core underlying aim are.</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">There is little doubt that the intention of this bill is to denationalise the English NHS, by removing the duties and powers of the SoS of state to provide a comprehensive service. </span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Thus the crossbencher Lord Owen has called this the “Secratary of State abdication bill”. This explains the furore around Clause one and related clauses on the Secretary of State’s duties and powers. This is a red line he will not give up. Why not return it to the original 2006 Act wording?</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">In addition the bill abolishes the previous planning structures of the NHS, with creation of a regulated external market in healthcare, with public provision of healthcare increasing being replaced by private provision (through the AQP policy), driven by a competitive market.<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">The Public Interest lawyer, Peter Roderick has stated:</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><i><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>“The fundamental legal basis for the NHS, which was put in place in 1946, will be removed by the Government’s Health and Social Care Bill.” </span></i><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">He goes on to state that: </span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><i><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">“a direct line of logic can now be traced in the Bill, which leads to the unavoidable conclusion that if the Bill was to be enacted, the legal stage would be set for private companies to be entitled to run much of the NHS and for market forces to determine the way many health services are provided."</span></i><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">The number of services provided by the NHS will decline over the next few years and increasing numbers of patients will take out health insurance to widen their coverage. This process will be catalysed by the QIPP efficiency drive as services start to fail and CCGs come under enormous pressure to reduce costs. This will then place enormous financial pressure on FTs, which will need to treat increasing proportions of private patients to stay afloat. This is why Priavte Patient cap is being uplifted to 49%.</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Over a 5-10 year period we will see the NHS transform in to a mixed funding system</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">This will all have detrimental effects on professionalism and professional standards</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Markets fundamentally undermine professionalism.</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">The relationships between medical professionals and patients depend on trust rather than contractual obligations and attempting to reduce the provision of healthcare to economic transactions erodes the intrinsic motivations on which the doctor-patient relationships depend. </span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">This strikes right at the heart of the social contract, which is fundamental to medical practice and professionalism. So it also strikes at the heart of this College. As Professor Kenneth Arrow recently stated about markets in healthcare <i>“one problem we have now, is an erosion of professional standards”</i></span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">It is therefore no coincidence that the American medical profession lost public support faster than any other profession during the rapid marketisation of the US healthcare system in the 1970/80s</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Doctors intrinsically want to work collaboratively. A MORI survey of doctors showed that competition was the biggest problem they had with the reforms.</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">This clearly leaves Mr Lansley with a huge problem with his reform agenda because as he stated in a speech to the NHS confederation: <i>“the first guiding principle is this: maximise competition…... which is the primary objective”</i></span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-bidi-font-style: italic; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Another issue is that clinical leadership and clinical followership are crucial to successful healthcare reform. Mr Lansley has lost the healthcare professions. The reforms are doomed to failure</span><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">The Colleges should also be very concerned about the effect of market reforms on medical training and standards. The profession has already suffered the Modernising Medical Careers (MMC) debacle, which can in part be explained by the influence of market based policies. MMC utilised a competency based tick box approach to training and it is important to note that Competency Based Training (CBT) originated in the 1980s and was a politically driven movement with the aim of making national workforces more competitive in the global markets by focusing on discrete technical skills with an emphasis on outputs, performance assessment, and value for money. However, the professional skills of doctors are much more based on tactic and experiential knowledge.</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Sir John Tooke’s report on MMC, Aspiring to Excellence, clearly highlighted MMC’s emphasis on achieving minimal standards rather than excellence35. A prescient editorial in the British Journal of General Practice described how the proposals for the establishment of PMETB: </span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><i><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">“… are clearly intended to enable the Secretary of State of the day to direct that standards can be lowered to meet the manpower demands of the NHS”</span></i><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">I will leave you with a quote from Arnold Relman, Emeritus Professor of Medicine of Harvard Medical School, and former editor of the New England Journal of Medicine:</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">“<i>Medical professionalism cannot survive in the current commercialized health care market. The continued privatization of health care and the continued prevalence and intrusion of market forces in the practice of medicine will not only bankrupt the health care system, but also will inevitably undermine the ethical foundations of medical practice and dissolve the moral precepts that have historically defined the medical profession.”</i></span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">.</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">In summary,</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">This bill is flawed. It lacks a democratic mandate. The case for such radical change has not been made. NHS productivity is increasing and patient satisfaction is at the highest levels ever recorded. Bureaucracy will be increased, not decreased. The bill lacks professional and public support (YouGov poll). We haven’t seen the risk register. It is unamendable due to the mutually reinforcing nature of the market policies, which are therefore the Coalition’s red line in the sands.</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Costs will go up and not down. The service will be fragmented and the transactional nature of the new healthcare market will undermine medical professionalism and the doctor patient relationship.</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">The latest amendments do little address the fundamental underlying structural changes of the bill that will undermine the NHS</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">For these reasons, the College should continue to oppose the bill, but more that that the college should join with other professional organisations and call for withdrawal of the bill<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt;"><span style="color: #222222; font-family: 'Arial','sans-serif'; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">The fellows are ready to get behind the College to back them every step of the way. Please vote for the motion in all it parts to protect the NHS and the future interests of our fellows."</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div>Clive Peedellhttp://www.blogger.com/profile/14800348230625234141noreply@blogger.com1tag:blogger.com,1999:blog-3422931188472387286.post-87820439843382253402012-02-18T01:08:00.002+00:002012-02-18T01:23:53.519+00:00Royal College of Radiologists Extraordinary General Meeting<span style="font-size: large;">RCR EGM 16th February 2012</span><br />
<br />
I made following speech at the RCR EGM to support the motion below.<br />
The motion was supported in full. The full results can be found <a href="http://www.rcr.ac.uk/docs/about/pdf/Post_EGM_16212.pdf">here</a>.<br />
(Please note the number of abstentions for the Council's own motion)<br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">That this meeting:</span></b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">(a) welcomes the RCR statement that it cannot support, and must continue to oppose the passage of the Health and Social Care Bill in its current form;</span></b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">(b) considers that the Health and Social Care Bill, if passed, will damage the NHS and widen healthcare inequalities, with detrimental effects on patient care in England;</span></b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">(c) cannot support the Health and Social Care Bill without seeing the NHS reform Risk Register<br />
(d) calls upon the RCR to publicly call for withdrawal of the Health and Social Care Bill;<br />
(e) calls upon the RCR to seek an alliance with the BMA, RCN, RCM and other willing Royal Colleges and NHS stakeholder organisations to collectively call for the withdrawal of the Health and Social Care Bill.</span></b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">(f) calls upon the RCR to hold a joint press conference with the BMA and other willing Royal Colleges and NHS stakeholder organisations, to make a joint public statement calling for the bill to be withdrawn</span></b></div><br />
<strong><u>Speech</u></strong><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">"I would like to thank Council and the President for calling this important meeting</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">I am co-chair of the NHS Consultants’ Association, a member of BMA Council and the Political Board.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">This is not a party political issue. I campaigned against New Labour’s market based NHS reforms because I believe that a publicly funded, publicly provided, and publically accountable NHS is the most cost effective and equitable way of delivering healthcare to our population.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">This is about defending the NHS from increasing marketisation and privatisation, which will inevitably undermine the founding principles of the NHS, leading to increasing healthcare inequalities, reduced access to care, increased healthcare expenditure, and the undermining of medical professionalism and the doctor-patient relationship</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">I don’t accept and I don’t think anyone accepts the status quo. I think we all realise that the NHS has problems and we would all agree that the NHS needs to continuously adapt, change and improve to meet the current and future health needs of the nation. But this has always been the case and will continue to be so. It is part of the duty of being a doctor.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">However, we will hear today why the Health and Social Care Bill is not the answer to the problems of the NHS and will in fact make things worse not better. We’ll also hear why the case for such a radical change to the NHS has not been made. </div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">Not only is the bill 3 times longer than the original bill and littered with 100s of new amendments, there is widespread recognition that something is deeply wrong with this bill. The level of opposition is unprecedented and ranges from the usual suspects of the unions, right through to members of the Cabinet of the Government. There are at least 23 professional groups in opposition including frontline staff as well as NHS managers. The highly critical joint editorial from the BMJ, HSJ and Nursing Times was a watershed moment.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">Surveys of the RCGP have shown that the vast majority want the bill withdrawn.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">Clare Gerada has stated:</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">“GPs don’t think the bill is going to create a patient led NHS, they don’t think it is going to increase autonomy, they don’t think it is going to improve patient care, and they don’t think it is going to improve healthcare inequalities”</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">Professor Lyndsey Davies, Chair of the UK FPH, which has just publicly called for withdrawal of the bill, has <a href="http://www.fph.org.uk/">stated</a> that: “the majority of our members now believe that the Health and Social Care Bill, if passed, will damage the NHS and the health of people in England”</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">There is also great confusion about what the bill actually means. Hamish Meldrum said it was “Hopelessly complex”. The new Chair of the NHSCB, Professor Malcolm Grant, who is a lawyer, said it was “unintelligible”.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">However, experts in constitutional, public and commercial law, as well as health policy have written extensively about the bill and published their analyses in major medical journals to explain what the core underlying aim are.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">There is little doubt that the intention of this bill is to denationalise the English NHS, by removing the duties and powers of the SoS of state to provide a comprehensive service. </div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">Thus the crossbencher Lord Owen has called this the “Secratary of State abdication bill”. This explains the furore around Clause one and related clauses on the Secretary of State’s duties and powers. This is a red line he will not give up. Why not return it to the original 2006 Act wording?</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">In addition the bill abolishes the previous planning structures of the NHS, with creation of a regulated external market in healthcare, with public provision of healthcare increasing being replaced by private provision (through the AQP policy), driven by a competitive market. <span style="mso-spacerun: yes;"> </span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">The Public Interest lawyer, Peter Roderick has stated:</div><div class="Default" style="margin: 0cm 0cm 0pt;"><i><span style="font-size: 11.5pt;"><span style="mso-spacerun: yes;"> </span>“The fundamental legal basis for the NHS, which was put in place in 1946, will be removed by the Government’s Health and Social Care Bill.”</span></i><i><span style="font-size: 8pt;"> </span></i><span style="font-size: 8pt;"></span></div><div class="Default" style="margin: 0cm 0cm 0pt;"><span style="font-size: 11.5pt;">He goes on to state that: </span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i><span style="font-size: 11.5pt;">“a direct line of logic can now be traced in the Bill, which leads to the unavoidable conclusion that if the Bill was to be enacted, the legal stage would be set for private companies to be entitled to run much of the NHS and for market forces to determine the way many health services are provided."</span></i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">The number of services provided by the NHS will decline over the next few years and increasing numbers of patients will take out health insurance to widen their coverage. This process will be catalysed by the QIPP efficiency drive as services start to fail and CCGs come under enormous pressure to reduce costs. This will then place enormous financial pressure on FTs, which will need to treat increasing proportions of private patients to stay afloat. This is why Priavte Patient cap is being uplifted to 49%.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">Over a 5-10 year period we will see the NHS transform in to a mixed funding system</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">This will all have detrimental effects on professionalism and professional standards</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">Markets fundamentally undermine professionalism.</div><div class="Default" style="margin: 0cm 0cm 0pt;"><span style="font-size: 11.5pt;">The relationships between medical professionals and patients depend on trust rather than contractual obligations and attempting to reduce the provision of healthcare to economic transactions erodes the intrinsic motivations on which the doctor-patient relationships depend</span><span style="font-size: 11.5pt;">. </span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="font-size: 11.5pt;">This strikes right at the heart of the social contract, which is fundamental to medical practice and professionalism. So it also strikes at the heart of this College. As Professor Kenneth Arrow recently stated about markets in healthcare <i>“one problem we have now, is an erosion of professional standards”</i></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="font-size: 11.5pt;">It is therefore no coincidence that the American medical profession lost public support faster than any other profession during the rapid marketisation of the US healthcare system in the 1970/80s</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">Doctors intrinsically want to work collaboratively. A MORI survey of doctors showed that competition was the biggest problem they had with the reforms.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="font-size: 11.5pt;">This clearly leaves Mr Lansley with a huge problem with his reform agenda because as he stated in a speech to the NHS confederation: <i>“the first guiding principle is this: maximise competition…... which is the primary objective”</i></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="font-size: 11.5pt; mso-bidi-font-style: italic;">Another issue is that clinical leadership and clinical followership are crucial to successful healthcare reform. Mr Lansley has lost the healthcare professions. The reforms are doomed to failure</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="Default" style="margin: 0cm 0cm 0pt;"><span style="font-size: 11.5pt;">The Colleges should also be very concerned about the effect of market reforms on medical training and standards. The profession has already suffered the Modernising Medical Careers (MMC) debacle, which can in part be explained by the influence of market based policies. MMC utilised a competency based tick box approach to training and it is important to note that Competency Based Training (CBT) originated in the 1980s and was a politically driven movement with the aim of making national workforces more competitive in the global markets by focusing on discrete technical skills with an emphasis on outputs, performance assessment, and value for money. However, the professional skills of doctors are much more based on tactic and experiential knowledge.</span></div><div class="Default" style="margin: 0cm 0cm 0pt;"><span style="font-size: 11.5pt;">Sir John Tooke’s report on MMC, Aspiring to Excellence, clearly highlighted MMC’s emphasis on achieving minimal standards rather than excellence</span><span style="font-size: 8pt;">35</span><span style="font-size: 11.5pt;">. A prescient editorial in the British Journal of General Practice described how the proposals for the establishment of PMETB: </span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i><span style="font-size: 11.5pt;">“… are clearly intended to enable the Secretary of State of the day to direct that standards can be lowered to meet the manpower demands of the NHS”</span></i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">I will leave you with a quote from Arnold Relman, Emeritus Professor of Medicine of Harvard Medical School, and former editor of the New England Journal of Medicine:</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="font-size: 11.5pt;">“<i>Medical professionalism cannot survive in the current commercialized health care market. The continued privatization of health care and the continued prevalence and intrusion of market forces in the practice of medicine will not only bankrupt the health care system, but also will inevitably undermine the ethical foundations of medical practice and dissolve the moral precepts that have historically defined the medical profession.”</i></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">In summary,</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">This bill is flawed. It lacks a democratic mandate. The case for such radical change has not been made. NHS productivity is increasing and patient satisfaction is at the highest levels ever recorded. Bureaucracy will be increased, not decreased. The bill lacks professional and public support (YouGov poll). We haven’t seen the risk register. It is unamendable due to the mutually reinforcing nature of the market policies, which are therefore the Coalition’s red line in the sands.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">Costs will go up and not down. The service will be fragmented and the transactional nature of the new healthcare market will undermine medical professionalism and the doctor patient relationship.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">The latest amendments do little address the fundamental underlying structural changes of the bill that will undermine the NHS</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">For these reasons, the College should continue to oppose the bill, but more that that the college should join with other professional organisations and call for withdrawal of the bill<span style="mso-spacerun: yes;"> </span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">The fellows are ready to get behind the College to back them every step of the way. Please vote for the motion in all it parts to protect the NHS and the future interests of our fellows."</div>Clive Peedellhttp://www.blogger.com/profile/14800348230625234141noreply@blogger.com2tag:blogger.com,1999:blog-3422931188472387286.post-34450816475566481902012-02-13T01:58:00.000+00:002012-02-13T01:58:47.274+00:00“When” becomes “If”. The bill can be defeated with united professional and public opposition<div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span lang="EN" style="color: windowtext; font-size: 12pt; font-weight: normal; mso-ansi-language: EN; mso-bidi-font-weight: bold;"><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"><strong>"When" becomes "if"</strong></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Something remarkable is happening in the political discourse surrounding the parliamentary passage of Health and Social Care Bill. Suddenly the language is changing from <i style="mso-bidi-font-style: normal;">"when" the bill is enacted</i> to <i style="mso-bidi-font-style: normal;">"if" the bill is enacted</i>. A good case in point can be found in Professor Paul Corrigan’s <a href="http://www.pauldcorrigan.com/Blog/health-and-social-care-bill/a-new-strong-position-emerges-against-the-bill-and-in-favour-of-nhs-reform/"><span style="color: blue;">latest blog</span></a>. He is a respected NHS commentator and a former health policy advisor to Tony Blair and remains in close contact with the corridors of power. He has his finger on the pulse and is now using the <i style="mso-bidi-font-style: normal;">“if”</i> word about the bill. Considering the parliamentary maths is so in favour of passage of the bill, this truly is an incredible sea change in opinion. He is not the only one to be saying their, either, with many commentators going further and actually <a href="http://www.newstatesman.com/health/2012/01/health-service-nhs-reforms"><span style="color: blue;">calling for the bill to be dropped</span></a> . Only a few months ago, I was being repeatedly told that this was impossibility.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">The NHS is now once again a big political football and it is clear that the Tories have retoxified themselves on this issue.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">A new <a href="http://www.guardian.co.uk/politics/2012/feb/12/nhs-bill-toxic-conservatives-lansley"><span style="color: blue;">YouGov poll highlighted in the Guardian</span></a>, reveals the extent of the damage being inflicted on the Tories and LibDems by the controversial bill. It shows that 62% of voters do not trust ministers on the health service, nearly double the 34% who say they do. Among Tory voters, nearly a quarter (24%) said they did not now trust their own government to handle the NHS, a belief shared by 59% of Liberal Democrat voters. So the LibDems are also toxic now.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">In addition another <a href="http://www.fph.org.uk/fph_calls_on_government_to_withdraw_health_and_social_care_bill_%27in_best_interests_of_everyone%27s_health%27"><span style="color: blue;">YouGov poll</span></a> shows 50 per cent of people reckon the Health Bill should be dropped, against 23 per cent who reckon it should stay. Some of the fieldwork was done before Friday's blow-up, when three cabinet ministers supported an editorial on the influential Conservative Home website, describing the NHS bill as <a href="http://conservativehome.blogs.com/thetorydiary/2012/02/the-unnecessary-and-unpopular-nhs-bill-could-cost-the-conservative-party-the-next-election-cameron-m.html"><span style="color: blue;">"potentially fatal to the Conservative party's electoral prospects"</span></a>.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Another story in the Daily Mail has suggested <a href="http://www.dailymail.co.uk/news/article-2099310/Tory-bust-health-reforms-amid-claims-minister-described-Camerons-poll-tax.html"><span style="color: blue;">half of the cabinet were in despair</span></a> and this was a poll tax moment. I actually <a href="http://www.hospitaldr.co.uk/blogs/nhs-consultants-association/were-seeing-the-conservatives-new-poll-tax"><span style="color: blue;">predicted this last year in a piece for Hospital Doctor</span></a>.<br style="mso-special-character: line-break;" /><br style="mso-special-character: line-break;" /></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">This really is crunchtime for the government. However, despite a <a href="http://www.newstatesman.com/blogs/the-staggers/2012/02/lansley-shot-taken-sylvester"><span style="color: blue;">rather vicious and brutal Number 10 briefing</span></a> against Mr Lansley, David Cameron has now backed him 100%. In the <a href="http://www.telegraph.co.uk/news/politics/9076891/David-Cameron-backs-beleaguered-Andrew-Lansley-in-NHS-row.html"><span style="color: blue;">Telegraph, Cameron stated</span></a>:</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">‘I am at one with Andrew Lansley, the reform programme and the legislation going through parliament’</span></i><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">More interestingly, <a href="http://www.bbc.co.uk/news/uk-17001118"><span style="color: blue;">according to the BBC</span></a>, Cameron now wants to put choice and competition back at the heart of the reforms.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;"><span style="color: black; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">"Choice, competition and transparency may unsettle some people, but it's these things at the heart of our reform that will lead to the better NHS I care about and our country deserves."</span></i><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">This is despite all the political rhetoric of the last few months about focusing on <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><a href="http://healthandcare.dh.gov.uk/government-response-to-nhs-future-forum/"><span style="color: blue;">integrated care</span></a> </i></b>after the government said it would accept all the Future Forum recommendations in full, which included rowing back on the pro-competition aspects of the bill. Competition was also the biggest issue to frontline doctors, according to <a href="http://web2.bma.org.uk/pressrel.nsf/wlu/STRE-8EKDTE?OpenDocument&vw=wfmms"><span style="color: blue;">an Ipsos MORI poll</span></a>. So this apparent change back to pro-competition, pro-market principles appears to suggest that Cameron is taking a much more belligerent approach to forcing the bill through. This may be because he feels that the <a href="http://www.dailymail.co.uk/news/article-2099914/NHS-reforms-David-Cameron-lashes-Cabinet-stabbers-support-Andrew-Lansley.html"><span style="color: blue;">Tories have now spilt so much blood</span></a> on this issue, that they might as well gamble and go for a more radical approach in keeping with the original full blooded market principles of the bill. This is interesting from a philosophical point of view, because the pro-marketeers in the Tory party are driven by a neoliberal ideology, which completely rejects the collectivist idea of a NHS. Since the <i style="mso-bidi-font-style: normal;">NHS is a <span style="display: none; mso-hide: all;"><br />
</span><span style="mso-bidi-font-weight: bold;">unique example</span> of the <span style="mso-bidi-font-weight: bold;">collectivist</span> provision of health care in a market society</i> (<a href="http://www.amazon.co.uk/New-Politics-NHS-Creation-Reinvention/dp/1846194091/ref=sr_1_2?s=books&ie=UTF8&qid=1329093677&sr=1-2"><span style="color: blue;">Rudolph Klein</span></a>), there is nothing more that they would like to see, than the end of the NHS. This is because collectivism is the enemy of the market (See <a href="http://cup.columbia.edu/book/978-0-7486-3268-8/neoliberal-ideology"><span style="color: blue;">Neoliberal Ideology – History, Concepts, Policies</span></a> by Rachel S Turner for an excellent overview). They may feel they have already blown their chances at the next election, so this just might be a way of destroying the NHS as a publicly provided service once and for all, because it likely to be irreversible. This is pure speculation of course, but whatever the real reasons behind Cameron’s decision to plough on, he and his party, along with the Liberal Democrats are in an awful position – a classic Catch 22. </span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Now that Cameron has made this decision, opponents need to turn up the heat on him and the LibDems as much as possible. A united front from medical professional organisations is a key way to raise the temperature and this is building up nicely with Extraordinary General Meetings of various Colleges, as well as new surveys and ballots. Paul Corrigan’s <a href="http://www.pauldcorrigan.com/Blog/health-and-social-care-bill/a-new-strong-position-emerges-against-the-bill-and-in-favour-of-nhs-reform/"><span style="color: blue;">blog</span></a> suggested that medical opposition would wane and become untenable, but he has completely failed to acknowledge that the <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">“NHS Spring”</i></b> also involves lots of other professional groups who openly oppose the Health and Social Care Bill, including the following:</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Royal College of Nursing</span></i></b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Royal College of Midwives</span></i></b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Chartered Society of Physiotherapists</span></i></b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Who all signed <a href="http://www.guardian.co.uk/society/2012/feb/07/lords-reject-nhs-bill?newsfeed=true"><span style="color: blue;">this open letter with BMA</span></a> calling for withdrawal of the bill</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Community Practioners and Health Vistitors Assocaition <a href="http://www.unitetheunion.org/news__events/latest_news/pressure_mounts_as_health_visi.aspx"><span style="color: blue;">CPHVA</span></a> </span></i></b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">NHS Managers – <a href="http://www.miphealth.org.uk/News/HomepageNews-30772_1.aspx"><span style="color: blue;">Management in Practice</span></a> </span></i></b><b style="mso-bidi-font-weight: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">and<i style="mso-bidi-font-style: normal;"> <a href="http://www.managementinpractice.com/article/28129/NHS_managers_oppose_Health_Bill"><span style="color: blue;">Institute of Healthcare Management</span></a><br />
<br style="mso-special-character: line-break;" /></i></span></b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"><a href="http://www.ahpf.org.uk/member_organisations.htm"><span style="color: blue;">Allied Health Professionals Federation</span></a></span></i></b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"> , which includes the following 12 organisations (120,000 members): </span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">The Society of Chiropodists and Podiatrists (SCP) </span></i></b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"><a href="http://www.sor.org/news/reforms-are-genuine-risk-quality-patient-care-0"><span style="color: blue;">The Society and College of Radiographers</span></a> (SCoR) </span></i></b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">The Royal College of Speech and Language Therapists (RCSLT) </span></i></b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">The College of Paramedics (COP) </span></i></b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">The Chartered Society of Physiotherapy (CSP) </span></i></b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">The British Association of Occupational Therapists/ College of Occupational Therapists (BAOT, COT) </span></i></b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">The British and Irish Orthoptic Society (BIOS) </span></i></b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">The British Association of Prosthetists and Orthotists (BAPO) </span></i></b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">The British Dietetic Association (BDA) </span></i></b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">The British Association of Drama Therapists (BADT) </span></i></b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">The British Association of Art Therapists (BAAT) </span></i></b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">The Association of Professional Music Therapists (APMT)</span></i></b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"><br style="mso-special-character: line-break;" /></span></i></b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">This level of opposition is unprecedented. A joint press conference calling for withdrawal of the bill, with all these groups plus the BMA and willing Royal Colleges would defeat this bill. I believe the Parliamentary maths would be irrelevant in this context. In fact, many healthcare professionals already believe that the bill is so flawed, it would be detrimental to patient care to enact. This is certainly the view of the UK Faculty of Public Health, which <a href="http://www.fph.org.uk/fph_calls_on_government_to_withdraw_health_and_social_care_bill_%27in_best_interests_of_everyone%27s_health%27"><span style="color: blue;">issued a press statement</span></a> calling for withdrawal of the bill and stated that:</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;"><span lang="EN" style="mso-ansi-language: EN; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">“the results of our latest survey of members found that 93% of those responding said that the Health and Social Care Bill, if passed, would damage the NHS and the health of people in England<b style="mso-bidi-font-weight: normal;">”</b></span></i><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="background: white; margin: 12pt 0cm; mso-outline-level: 2;"><i style="mso-bidi-font-style: normal;"><span style="mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">“</span></i><i style="mso-bidi-font-style: normal;"><span lang="EN" style="mso-ansi-language: EN; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">FPH calls on government to withdraw Health and Social Care Bill 'in best interests of everyone's health'”</span></i><b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></b></div><div class="MsoNormal" style="background: white; margin: 12pt 0cm; mso-outline-level: 2;"><span lang="EN" style="mso-ansi-language: EN; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">How on earth can Mr Cameron and his Liberal Democrat allies carry on with this bill and retain any credibility with the health professions, other NHS staff, and with the public?</span><b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></b></div><div class="MsoNormal" style="background: white; margin: 12pt 0cm; mso-outline-level: 2;"><span lang="EN" style="mso-ansi-language: EN; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Mr Cameron must withdraw the bill. In return, he must be allowed an exit strategy to do this.</span></div></span></div>Clive Peedellhttp://www.blogger.com/profile/14800348230625234141noreply@blogger.com1tag:blogger.com,1999:blog-3422931188472387286.post-30698270379415492692012-01-31T23:37:00.001+00:002012-01-31T23:43:32.137+00:00College antics and my motion for the Royal College of Radiologists EGM<div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="font-size: large;">More on the Colleges</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">Following last week’s behind the scenes antics that led to the failure of the Academy of Medical Royal Colleges to release an agreed joint press statement about the Health and Social Care Bill, ordinary members and fellows have been venting their frustration at their College Presidents.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">Their voice has been amplified by the technology of social media such as Twitter, Facebook and various blogs. <a href="http://drdavidwrigley.blogspot.com/">Dr David Wrigley</a>, a member of BMA Council, has set up the <a href="http://callonyourcollege.blogspot.com/">Lobby Your College</a> website, which is endorsed by the NHS Consultants’ Association (which I co-chair). It has received nearly 6,000 hits in less than a week, turning up the heat on the Colleges.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">This outpouring of frustration and anger at the Colleges is not surprising when you get an idea of what actually happened last week. The President of the Royal College of Psychiatrists, Professor Dr Sue Bailey, gave a remarkable insight in <a href="http://www.rcpsych.ac.uk/members/thepresidentsblog/aninteresting24hours.aspx">her blog</a>.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">This was the most important sentence:</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">“<span style="color: #111144;">I left the Academy building at 2.30pm on Tuesday afternoon in the honest and 100% belief that we had an agreed statement, which would absolutely acknowledge that the only College dissenting from this view was <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">the Royal College of Surgeons in England</i></b>.” (<b style="mso-bidi-font-weight: normal;">ed</b>)</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="color: #111144;">For starters, this is a significant indictment of the lack of solidarity the RCS showed to the rest of the profession </span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="color: #111144;">The Academy statement included the following strongly worded sentence, which would have had devastating to Lansley’s beleaguered reforms, coming form 19/10 Colleges:</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="color: #111144;">“<em>The Academy and Medical Royal Colleges are not able to support the Bill as it currently stands.</em> <em>Unless the proposals are modified the Academy believes that Bill may widen rather than lessen health inequalities and that unnecessary competition will undermine the provision of high quality integrated care to patients.”</em></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><em><span style="color: #111144; font-style: normal; mso-bidi-font-style: italic;">The piles the pressure on the Royal College of Surgeons, which looks even more out of touch and isolated after today’s BMJ editorial by Walshe, which states:</span></em></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;"><span lang="EN" style="color: #333333; mso-ansi-language: EN;">“Even at this late stage, the government would be wise to withdraw the bill”</span></i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span lang="EN" style="color: #333333; mso-ansi-language: EN;">This editorial effectively demolishes the <a href="http://www.rcseng.ac.uk/news/rcs-health-bill-statment-rcs-calls-for-more-detail-on-clinical-involvement-in-commissioning">latest RCS position</a> on the bill, which states:</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;"><span lang="EN" style="color: #333333; mso-ansi-language: EN;">“</span></i><i style="mso-bidi-font-style: normal;"><span lang="EN" style="mso-ansi-language: EN;">The College also encourages the <span class="highlightedsearchterm">Bill</span> to be implemented without unnecessary delay, otherwise we believe that delays to this process will ultimately be to the detriment of patients.”</span></i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span lang="EN" style="mso-ansi-language: EN;">Quite frankly, this is a scary statement considering no one has seen the NHS reform Risk Register, which Lansley refuses to release despite be <a href="http://www.thisislondon.co.uk/standard/politics/article-24008861-lansley-ordered-to-reveal-secret-health-report.do"><span style="color: blue;">instructed to do so by the information Commissioner</span></a>. I’m sure surgeons wouldn’t operate on a patient without knowing about their medical history and anesthetic risks!</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">Too many Royal Colleges have failed to survey the views of their members and reflect the detailed published critiques of the Health and Social Care Bill. They seem to ignore the fact that the only way to understand this bill with a degree of authority is to have expertise in constitutional law, public law, commercial law and health policy. None of the Colleges have this expertise in-house, unlike the BMA which has a legal team and a Health Policy and Economic Research Unit. The BMA position is a democratically mandated position of opposition to the bill in it’s entirety. That is also the view of the only independent team of experts that have all the health policy expertise necessary to unravel this bill, namely Allyson Pollock et al’s team of lawyers and health policy academics.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">It is therefore also worrying the <a href="http://www.rcpch.ac.uk/what-we-do/college/rcpch-officers/college-officers">Professor Terence Stephenson</a> of the <a href="http://www.rcpch.ac.uk/">Royal College of Paediatrics and Child Health</a> has called on his <a href="http://www.rcpch.ac.uk/child-health/standards-care/health-policy/health-and-social-care-bill/health-and-social-care-bill">College Officers to make judgements</a> on the bill rather than listening to the experts and his wider membership.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">My own College, the <u><a href="http://www.rcr.ac.uk/docs/newsroom/pdf/RCR_statement_re_HSC_Bill_270112.pdf">Royal College of Radiologists (RCR) has taken a much more sensible approach and has effectively backed the original Academy statement</a></u> by stating that the College cannot accept the bill as it currently stands and must continue to oppose it. However this doesn’t go far enough, so I personally called for an Extraordinary General Meeting (EGM) of the RCR to debate motions regarding the bill. The Bye Laws of the RCR state that 40 Fellows are required to call for an EGM and I achieved this within a morning. However the RCR Council called the EGM themselves, before I submitted the names. Good on them, I say!</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">I have since sent the following motion to the EGM, which has been accepted by the Chief Executive of the RCR for debate. This also required 40 Fellows and over 60 have now signed up. There have been a couple of dissenters that say that this is too political and nothing to do with the College, but this <a href="http://www.nhsca.org.uk/docs/nhscarcp.pdf">open letter penned to the Colleges</a> last year, <a href="http://www.nhsca.org.uk/docs/nhscasig.pdf">signed by these doctors</a> demolishes their arguments. The bill will fundamentally undermine professional values and the doctor patient relationship, and will have negative consequences for education and training standards. This is everything to do with the Colleges. </div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">Here is the motion to be debated on the 16<sup>th</sup> February 2012:</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">That this meeting:</span></b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">(a) welcomes the RCR statement that it cannot support, and must continue to oppose the passage of the Health and Social Care Bill in its current form;</span></b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">(b) considers that the Health and Social Care Bill, if passed, will damage the NHS and widen healthcare inequalities, with detrimental effects on patient care in England;</span></b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">(c) cannot support the Health and Social Care Bill without seeing the NHS reform Risk Register<br />
(d) calls upon the RCR to publicly call for withdrawal of the Health and Social Care Bill;<br />
(e) calls upon the RCR to seek an alliance with the BMA, RCN, RCM and other willing Royal Colleges and NHS stakeholder organisations to collectively call for the withdrawal of the Health and Social Care Bill.</span></b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><b><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">(f) calls upon the RCR to hold a joint press conference with the BMA and other willing Royal Colleges and NHS stakeholder organisations, to make a joint public statement calling for the bill to be withdrawn</span></b></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><br />
<br />
<span style="mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">I really hope that fellows of the RCR will set an example and set the ball in motion to finish off this disastrous bill. It is vitally important to realise that the policies that enshrined in this bill to deliver an external market driven health system, are mutually reinforcing. If one of these key policies falls, the whole edifice of the bill falls. That is precisely why the concessions Lansley will give to the Lords, will not be any of his key red lines polcies that deliver his market. Even the talk of “integration” is meaningless. For example, the disastrously expensive Health Maintenance Organisations in the United States are based on “integrated care” models. </span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">The bottom line is that a man that says “no top down reorganisation of the NHS”, when the NHS Chief Executive says the reforms “can be seen from space” is not to be trusted.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;">Let’s Kill the Bill.</span></div>Clive Peedellhttp://www.blogger.com/profile/14800348230625234141noreply@blogger.com5tag:blogger.com,1999:blog-3422931188472387286.post-52256012059186710162012-01-28T22:35:00.000+00:002012-01-28T22:35:15.068+00:001/20 - How the autocrats of the Royal College of Surgeons let down the profession and the NHS<strong>1/20 - </strong><strong>How the autocrats of the Royal College of Surgeons let down the profession and the NHS</strong> <div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">Tuesday 24<sup>th</sup> January 2012 was a momentous day for the NHS. The Academy of Medical Royal Colleges (AoMRC),which is the umbrella organisation that represents <a href="http://aomrc.org.uk/about-us/members/members.html">the main 20 UK medical Colleges and Faculties</a>, met to discuss the Health and Social Care Bill.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">They had produced a <a href="http://www.guardian.co.uk/politics/2012/jan/25/royal-medical-colleges-nhs-reforms">joint <span lang="EN" style="mso-ansi-language: EN;">statement that </span>was leaked to the Guardian</a>, which stated:</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;"><span lang="EN" style="mso-ansi-language: EN;">"The Medical Royal Colleges and Faculties of the AoMRC continue to have significant concerns over a number of aspects of the health bill and are disappointed that more progress has not been made in directly addressing the issues we have raised......"</span></i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;"><span lang="EN" style="mso-ansi-language: EN;">"....unless the proposals are modified the academy believes that bill may widen rather than lessen health inequalities and that unnecessary competition will undermine the provision of high quality integrated care to patients.”</span></i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;"><span lang="EN" style="mso-ansi-language: EN;">"The Academy is deeply concerned that the upheaval caused by the changes in the bill will distract the NHS from the huge task of meeting the current financial challenges."</span></i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;"><span lang="EN" style="mso-ansi-language: EN;">"The Academy and Medical Royal Colleges are not able to support the bill as it currently stands”</span></i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">This statement had been agreed by 19/20 of the organisations represented by the AoMRC. Only the Royal College of Surgeons of England (RCSE), led by <a href="http://www.rcseng.ac.uk/about/president">Professor Norman Williams</a> refused to sign the letter. This was expected to happen because despite having some concerns, Williams has been a longstanding proponent of the reforms, having previously stated that: </div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;"><span style="mso-spacerun: yes;"> </span>“The College largely supports the aims of the reforms to modernise the healthcare system”</i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">Unfortunately, this lack of solidarity with the rest of the profession provided the chink in the armour of a united front of professional opposition to the bill. The 19/20 organisations backing the statement, soon collapsed to 0/20, triggered by the Royal College of Obstetrics and Gynaecology pulling out, and catalysed by a frantic Health Secretary ringing around the College Presidents to apply some hefty political pressure. The statement was never officially released.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">This collapse in solidarity was a gift to Mr Lansley, and it was widely reported in the national media including BBC headlines:<span style="mso-ansi-language: EN;"> <span lang="EN">“<a href="http://www.bbc.co.uk/news/health-16743234">Government escapes rebellion by medics over NHS</a>”</span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">This was possibly the moment when the NHS was lost to the English public, in terms described in the <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60119-6/fulltext#article_upsell"><span style="color: blue;">Lancet</span></a> recently (Fulltext reproduced <a href="http://www.opendemocracy.net/ourkingdom/allyson-pollock-david-price-peter-roderick-tim-treuherz-david-mccoy-martin-mckee-lucy-rey">here</a>). I am convinced that a united front of opposition from the Colleges would have been enough to finish off the bill. Many commentators suggest that the reality of the Parliamentary maths would suggest otherwise, but I would them to consider the following situation:</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">A press conference with the BMA, Royal College of Nursing, Royal College Midwives, and the Academy of Medical Royal Colleges, all sat together signing a letter opposing the Health and Social Care Bill and calling for it to be withdrawn. This would be absolutely devastating for Lansley. Cameron’s pollsters would be calling time on the bill. They are twitched enough about it already.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">This is what is so disappointing. The bill had been brought to its knees by sustained campaigning and professional evidence based criticism, and just needed the Royal Colleges to deliver the final blow, as <a href="http://bevansrun.blogspot.com/2012/01/nhs-is-in-hands-of-medical-royal.html">I have explained before</a>. Instead, Norman Williams and his College of Surgeons performed life saving surgery on it. I’m sure Mr Lansley will be very grateful. The extent of this surgery can be seen by the RSCE’s press statement on their <a href="http://www.rcseng.ac.uk/news/health-and-social-care-bill-2013-update-on-latest-developments">current position on the bill</a>:</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span lang="EN" style="mso-ansi-language: EN;">“The College believes that the Bill should be implemented without unnecessary delays, as otherwise procrastination, without an alternative cogent plan, will lead to further chaos and be to the detriment of patients.”</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">This position of the College is based the views of the College Officers alone, because they have not surveyed the opinions of their paying members and fellows. This is the autocracy of the surgical establishment in action. Why they would support such a bill is an interesting topic for discussion and I recommend this interesting <a href="http://nhsvault.blogspot.com/2012/01/nhs-reform-goldmine-for-surgeons.html">blog article</a>, which goes into some the issues. </div><span lang="EN" style="mso-ansi-language: EN;">Despite the complete lack of solidarity shown by the Surgeons to the rest of the medical profession, all is not lost. If we can get back to a situation where the majority of the Royal Colleges make individual statements about opposing the bill, this could actually be even more powerful. There is a big opportunity to put the surgeons out in the cold over this. If 19 Colleges signed a joint letter, there is no reason why this cannot happen again on an individual basis. In addition, the Colleges can hardly use the claim of being “apolitical” anymore, especially following the frantic antics of Lansley, and the desire of some College Presidents to meet senior Ministers for more discussions!</span><br />
<div style="margin: 0cm 0cm 0pt;"><span lang="EN" style="mso-ansi-language: EN;">The process for this to happen is already in train. The UK Faculty of Public Health have had an Emergency General Meeting and voted overwhelmingly for the bill to be withdrawn. Since the Academy meeting, The College of Emergency Medicine has now stated that:</span></div><div style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;"><span lang="EN" style="mso-ansi-language: EN;">“</span>The College of Emergency Medicine has significant concerns over a number of aspects of the Bill and is not able to support it in its current form”</i></div><div style="margin: 0cm 0cm 0pt;"><br />
</div><div style="margin: 0cm 0cm 0pt;">The Royal College of<span style="mso-spacerun: yes;"> </span>Radiologists has now issued <a href="http://www.rcr.ac.uk/docs/general/other/RCR_Special_eBulletin_Health_Bill_270112.html"><span style="color: windowtext;">this statement</span></a>, which said:</div><div style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;">“Given our widespread concerns over many serious and as yet unresolved issues, The Royal College of Radiologists cannot support, and must continue to oppose, the passage of the Health and Social Care Bill in its current form”</i></div><div style="margin: 0cm 0cm 0pt;">It has also called for <a href="" name="OLE_LINK2"></a><a href="" name="OLE_LINK1"><span style="mso-bookmark: OLE_LINK2;">an Extra-Ordinary General Meeting </span></a>of Fellows to debate the bill and form policy.</div><div style="margin: 0cm 0cm 0pt;"><br />
</div><div style="margin: 0cm 0cm 0pt;">The Royal College of Physicians has also been forced to have an Extra-Ordinary General Meeting by it Fellows and will be making a statement next week.</div><div style="margin: 0cm 0cm 0pt;">Other ordinary College fellows and members are working on the Colleges too. A College <a href="http://callonyourcollege.blogspot.com/">lobbying website</a> for members and fellows has also been set up. <span lang="EN" style="mso-ansi-language: EN;"></span></div><div style="margin: 0cm 0cm 0pt;"><br />
</div><div style="margin: 0cm 0cm 0pt;"><span lang="EN" style="mso-ansi-language: EN;">Next week is going to be a big week for the NHS. The damage caused by the Royal College of Surgeons of England can be repaired, but only if the other Colleges wake up the reality that the bill is unamendable. They must realise that they cannot support this bill, especially when the issues surrounding Clause 1 and related Clauses have not been resolved, and the risk register is being held back. I have been campaigning against this bill for a long time and have witnessed Lansley use every trick in the book to force this bill through. The so called “major concessions” on the bill so far are mainly cosmetic and simply do not protect the NHS from increasing commercialisation and privatisation. There is simply too little Parliamentary time to allow for proper scrutiny of more concessions because of the complexity of the bill. The true meaning of any new changes and their knock on effects with other parts of the bill can take weeks to sort out. In addition the potential for unintended consequences is much greater with complex legislation. <span style="mso-spacerun: yes;"> </span></span></div><div style="margin: 0cm 0cm 0pt;"><br />
</div><div style="margin: 0cm 0cm 0pt;"><span lang="EN" style="mso-ansi-language: EN;">So it is now time for the College Presidents to stand up for the public interest, the NHS and patients. They should listen to the majority view of the medical profession, and the views of the <a href="http://www.guardian.co.uk/society/2011/sep/06/orwellian-language-of-nhs-reform">academic health policy community</a>, and call for the bill to be withdrawn. It is too dangerous for the NHS to allow this bill to pass into law.</span></div>Clive Peedellhttp://www.blogger.com/profile/14800348230625234141noreply@blogger.com1tag:blogger.com,1999:blog-3422931188472387286.post-3647953310615129782012-01-24T18:41:00.004+00:002012-01-24T18:56:22.557+00:00The Open Letter to the Royal College Presidents<div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><b style="mso-bidi-font-weight: normal;"><span style="mso-fareast-language: EN-GB;">An open letter to the <placename w:st="on"><place w:st="on">Royal</place> <placetype w:st="on">College</placetype></placename> Presidents regarding the Health and Social Care Bill</span></b></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="color: #646464; font-family: 'Arial','sans-serif'; font-size: 9pt;"><span style="color: black;">This open letter was sent to the Royal College Presidents in September last year. It was signed by </span><a href="http://www.nhsca.org.uk/docs/nhscasig.pdf"><span style="color: black;"><strong>these doctors</strong></span></a></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="color: #646464; font-family: 'Arial','sans-serif'; font-size: 9pt;"><span style="color: black;">and was reported in the </span><a href="http://www.guardian.co.uk/society/2011/sep/11/doctors-letter-resists-nhs-reform?CMP=twt_fd"><span style="color: black;"><strong>Guardian</strong></span></a><span style="color: black;">, but at that time the Colleges failed to act decisively and come in line with the majority view of the profession.</span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="color: #646464; font-family: 'Arial','sans-serif'; font-size: 9pt;"><span style="color: black;">Now that the Royal College of Nursing and the Royal College of Midwives have joined the BMA in opposing the Health and Social Care Bill and calling for its withdrawal, the Medical Royal Colleges now find themselves in a pivotal position, where their united opposition could result in the bill falling. I have therefore decided to put the open letter on my blog for a wider audience because it explains the key reasons and arguments for why the Medical Royal Colleges should oppose the Health and Social Care Bill and call for its withdrawal.</span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
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</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="color: #646464; font-family: 'Arial','sans-serif';"><span style="mso-fareast-language: EN-GB;"><span style="color: black;"><span style="font-family: Times New Roman;"><span style="font-size: large;">Dear Presidents,</span></span></span></span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="color: #646464; font-family: 'Arial','sans-serif'; font-size: 9pt;">“The Academy’s role is to promote, facilitate and where appropriate co-ordinate the work of the <placename w:st="on"><place w:st="on"><placename w:st="on">Medical</placename> <placename w:st="on">Royal</placename> <placetype w:st="on">Colleges</placetype></place></placename> and their Faculties for the benefit of patients and healthcare.”</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="color: #646464; font-family: 'Arial','sans-serif'; font-size: 9pt;"><a href="http://aomrc.org.uk/"><span style="mso-bidi-font-family: Arial;">Academy of Medical Royal Colleges</span></a> </span><span style="mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
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</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">We write to persuade you that the Royal Colleges' current policy of cooperating with the government’s proposed NHS reforms in England as stated in the 2011 Health and Social Care Bill is not in keeping with the wishes of the majority of the medical profession and not in the best long-term interests of either patients, doctors or the Royal Colleges.<span style="mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><u><span style="mso-fareast-language: EN-GB;"><span style="text-decoration: none;"></span></span></u></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><u><span style="mso-fareast-language: EN-GB;">Current situation</span></u></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-language: EN-GB;">Following the unprecedented pause in the passage of the Health and Social Care Bill to allow for a “listening exercise”, it has become clear that the Government’s proposed changes to the Bill<sup>1</sup> in response to the Future Forum report<sup>2</sup>, have done little to address the concerns of the medical profession. In fact, the representative body of the BMA reinstated its policy to call for withdrawal of the bill at its Annual Representative Meeting (ARM) in June. The key issues that were highlighted by the ARM were serious concerns regarding:</span></div><div class="MsoListParagraphCxSpFirst" style="margin: 0cm 0cm 0pt 54pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -36pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"><span style="mso-list: Ignore;">i)<span style="font-family: 'Times New Roman';"> </span></span></span><span style="mso-fareast-language: EN-GB;">the removal of the duty of the Secretary of State for Health to provide a comprehensive health service</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 54pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -36pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"><span style="mso-list: Ignore;">ii)<span style="font-family: 'Times New Roman';"> </span></span></span><span style="mso-fareast-language: EN-GB;">the role of Monitor in the promotion of competition</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 54pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -36pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"><span style="mso-list: Ignore;">iii)<span style="font-family: 'Times New Roman';"> </span></span></span><span style="mso-fareast-language: EN-GB;">the enforced nature of competition through the promotion of the choice agenda, as a higher priority than tackling fair access and health inequalities</span></div><div class="MsoListParagraphCxSpLast" style="margin: 0cm 0cm 0pt 54pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -36pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"><span style="mso-list: Ignore;">iv)<span style="font-family: 'Times New Roman';"> </span></span></span><span style="mso-fareast-language: EN-GB;">increasing marketisation and privatisation of the English NHS</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
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</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none; mso-pagination: none;"><u><span style="mso-font-kerning: .5pt;">Professional support is lacking </span></u></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-language: EN-GB;">In response to the Government’s failure to reassure the medical profession about its proposed changes, BMA Council subsequently voted in favour of starting a public campaign to call for withdrawal of the Health and Social Care Bill. Council also agreed that</span> the Government was “misleading the public by repeatedly stating that there will be no privatisation of the NHS”. <span style="mso-fareast-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Dr Hamish Meldrum, Chairman of the BMA said that:</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-language: EN-GB;">“</span>there is widespread feeling that the proposed legislation is hopelessly complex, and it really would be better if the Bill were withdrawn</i>”<sup>3</sup>.<span style="mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-language: EN-GB;">The RCGP survey of over 1,000 GPs following the Government response was also highly critical.</span><span style="color: #56606f; font-size: 8.5pt;"> </span>Dr Clare Gerada, Chair of the RCGP stated:</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;">‘ GPs don't think this bill is going to create a patient-led NHS, they don't think it's going to increase autonomy, they don't think it's going to improve patient care and they don't think it's going to reduce health inequalities.'<sup>4</sup></i><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-language: EN-GB;"></span></i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">An online BMJ poll of over 1000 doctors showed that 93% wanted the bill to be withdrawn and a smaller online poll by GP magazine showed that 94% thought the bill should be scrapped. The Government’s former Director for heart disease and stroke, Sir Roger Boyle, also spoke out against the bill. He pulled no punches when he stated that:</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><a href="about:blank" name="OLE_LINK18"><i style="mso-bidi-font-style: normal;"><span style="mso-spacerun: yes;"> </span>'It is horrific that the NHS's future is threatened'<sup>5</sup></i></a></div><span style="mso-bookmark: OLE_LINK18;"></span><br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span class="googqs-tidbit">Dr Evan Harris, the influential Liberal Democrat GP </span><em><span style="font-style: normal; mso-bidi-font-style: italic;">dismissed the NHS Future Forum report as </span>"cliché-ridden, trite nonsense"</em><em><span style="font-style: normal; mso-bidi-font-style: italic;"> and held out the prospect of further revolts<sup>6</sup></span></em><span class="googqs-tidbit"><i style="mso-bidi-font-style: normal;">. </i></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none; mso-pagination: none;"><u><span style="mso-font-kerning: .5pt;">Parliamentary and other support is lacking</span></u></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-language: EN-GB;">It is not just doctors who remain concerned by the Bill. </span>The Liberal Democrat MP and member of the<span lang="EN-US" style="mso-ansi-language: EN-US;"> Health Select Committee</span>, Andrew George <span lang="EN-US" style="mso-ansi-language: EN-US;">said:</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;"><span lang="EN-US" style="mso-ansi-language: EN-US;">“If the Government had been listening it would have scrapped the Bill. Instead it looks as if they've just massaged and tweaked it a bit.”</span></i><sup><span lang="EN-US" style="mso-ansi-language: EN-US;">7</span></sup><span style="mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">The concerns have also spread to highly influential members of the Lords. In her speech to the NHS Confederation, Baroness Williams stated that:</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;">“I would be less than candid if I failed to mention that there are still some unresolved and troubling issues to be addressed”<sup>8</sup></i><span class="googqs-tidbit"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-language: EN-GB;"></span></i></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-language: EN-GB;">It is also increasingly apparent that these widespread concerns are entirely justified.<span style="mso-spacerun: yes;"> </span>Most notably, t</span>he public interest lawyer, Peter Roderick, has stated that:</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;"><span lang="EN-US" style="mso-ansi-language: EN-US;">“The<strong> </strong><strong><span style="font-weight: normal; mso-bidi-font-weight: bold;">fundamental legal basis for the NHS</span></strong>, which was put in place in 1946, will be <strong><span style="font-weight: normal; mso-bidi-font-weight: bold;">removed</span></strong><b style="mso-bidi-font-weight: normal;"> </b>by the Government’s Health and Social Care Bill.”<sup>9</sup></span></i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span lang="EN-US" style="mso-ansi-language: EN-US;">He goes on to state that:</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><i style="mso-bidi-font-style: normal;">“</i></span><i style="mso-bidi-font-style: normal;">a direct line of logic can now be traced in the Bill, which leads to the unavoidable conclusion that if the Bill was to be enacted, the legal stage would be set for private companies to be entitled to run much of the NHS and for market forces to determine the way many health services are provided.<sup>9</sup></i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;">This is in entirely keeping with evidence recently published in the BMJ that the reforms will inevitably lead to further NHS privatisation and NHS asset stripping in England.<sup>10,11</sup></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><u>Democratic legitimacy?</u></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">Also of major concern is the <span style="mso-fareast-language: EN-GB;">lack of democratic legitimacy for this bill.</span> The 2010 Conservative Election Manifesto stated:</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i>“More than three years ago, David Cameron spelled out his priorities in three letters – NHS”</i> <b style="mso-bidi-font-weight: normal;"><span style="mso-fareast-language: EN-GB;"></span></b></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">This refers to the 2007 Conservative Party White Paper, <i>NHS Autonomy and Accountability. Proposals for legislation</i>”<sup>12</sup>. The introduction was written by David Cameron and Lansley, which stated:</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">“<i>Improving the NHS is the Conservative Party’s <span style="mso-bidi-font-weight: bold;">number one priority</span>....<span style="mso-bidi-font-weight: bold;">this requires an end to the pointless upheavals</span>, <span style="mso-bidi-font-weight: bold;">politically-motivated cuts</span>, increased bureaucracy and greater centralisation that have taken place under Labour..”</i> </div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">The document also states:</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">“<i style="mso-bidi-font-style: normal;">As part of our commitment to avoid organisational upheaval, we will retain <country-region w:st="on"><place w:st="on">England</place></country-region>’s ten SHAs, which will report to the NHS Board (para 4.28)”, and “PCTs will remain local commissioning bodies.”</i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">Professor Kieran Walshe also highlighted the fact that the Coalition agreement had specifically pledged to “<i>stop the top-down reorganisations of the NHS that have got in the way of patient care</i>”<sup>13</sup>. He estimated costs of reorganisation between £1.8billion and £3 billion<sup>14</sup>.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">The Liberal Democrat MP, Andrew George said that Lansley had "<i>Torn up the agreement to resist imposing a top-down re-organisation</i>" and Zack Cooper from the London School of Economics said: “<i>The new health secretary campaigned on a pledge to eliminate top-down shake ups of the health service. This white paper contradicts his campaign promise</i>”<sup>15</sup></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><u>Colleges responsibilities </u></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">In light of the above evidence, we believe that the Royal Colleges should be taking a much more active role in opposing this bill and should publicly back the BMA’s call for the bill to be withdrawn. In fact, s<span style="mso-fareast-language: EN-GB;">ince the BMA represents over two thirds of all practising doctors in all branches of medicine<sup>16</sup>, is it not incumbent upon the Royal Colleges to support the BMA’s position?</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-language: EN-GB;">Unfortunately, far from backing the BMA’s call for withdrawal of the bill, the AoMRC President, Sir Neil Douglas told the bill scrutiny committee that:</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>“...there are so many disadvantages in delaying that we have to get on with it to the best of our ability now. We will not be able to give you definitive answers on detailed questions because our members have not had a chance to respond, but we will do our best and we believe that we should be going forward at the moment.”</span></i><sup><span style="mso-fareast-language: EN-GB;">17</span></sup><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-language: EN-GB;"></span></i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-language: EN-GB;">However, surely any perceived need to avoid delay, as expressed by Sir Neil Douglas, is entirely due to the insistence by both Department of Health and the government on beginning implementation of the reforms before parliament has given its approval. This is at best undemocratic and quite possibly unconstitutional. As in athletics, jumping the gun should result in disqualification!</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-language: EN-GB;">In addition, the President of the Royal College of Surgeons, Professor Norman Williams has recently stated that the <i style="mso-bidi-font-style: normal;">“College largely supports the aims of the reforms to modernise the healthcare system.”</i><sup>18</sup></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-language: EN-GB;">Considering the continued widespread professional opposition to the bill, these are worrying statements that could be interpreted as showing that the Colleges are out of touch with the views and concerns of the majority of grassroots doctors. The question must therefore be asked as to why the Colleges, with the exception of the RCGP, have taken this position.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-language: EN-GB;">One explanation may be found in the Government’s response to the Future Forum report, which secures a number of important roles for the Colleges in delivering and leading the reforms</span><sup><span style="font-family: 'Syntax','serif'; font-size: 11.5pt; mso-bidi-font-family: Syntax;">2</span></sup><span style="mso-fareast-language: EN-GB;">. These roles include the establishment of close links with the NHS Commissioning Board (para 3.55), involvement in identifying the </span><span style="font-family: 'Syntax','serif'; font-size: 11.5pt; mso-bidi-font-family: Syntax;">procedures most at risk of cherry picking (para 5.42) and prioritising work on Payment by Results (para 5.42)</span><span style="mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-language: EN-GB;">Just as the Government has no mandate from the electorate to push through this bill, the Royal Colleges have no mandate from their Members and Fellows to help deliver and lead the reforms. In fact, it is unacceptable that the Colleges (with the notable exception of the RCGP) have not even surveyed the opinions of their members/fellows on such an important issue. </span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-language: EN-GB;">By taking this stance, not only are the Colleges failing to represent their members and fellows, we believe they also failing to safeguard their very own principles </span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-language: EN-GB;">One of the key roles of the Colleges is to </span><i style="mso-bidi-font-style: normal;">“promote the underlying principles of medical professionalism and leadership”</i><sup><span style="mso-fareast-language: EN-GB;">19</span></sup><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-language: EN-GB;"></span></i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-language: EN-GB;">However, the last 20 years of NHS reform has seen medical professionalism and the public service ethos increasingly undermined and eroded by market based policies and ideology.<span style="mso-spacerun: yes;"> </span>This is because neoliberal </span>market theories, such as public choice theory, reject the idea of the public service ethos and view public service professionals as self interested “rent seekers” whose real purpose is to make money and legitimise monopolistic cartels<sup> 20</sup>. Professor Julian <span style="mso-fareast-language: EN-GB;">Le Grand (former health policy advisor to Tony Blair)</span> noted how public choice theory had become influential under the Thatcher government from 1980’s onwards, and used the metaphorical model of<span style="mso-spacerun: yes;"> </span>“Knights, Knaves, Pawns<span style="mso-spacerun: yes;"> </span>and Queens” to describe how this had changed attitudes towards the motivations and behaviours of public service professionals. Public servants were increasingly viewed as essentially self-interested “knaves” rather than public-spirited altruists or “knights”, whereas service users were regarded as consumer “queens” rather than passive “pawns”. He argued that “<i style="mso-bidi-font-style: normal;">Public policy should be designed so as to empower individuals: turn pawns into queens</i>” with the ensuing logic that public services should be delivered through competition and consumer choice <sup>21</sup>. <i style="mso-bidi-font-style: normal;"><span style="mso-fareast-language: EN-GB;"></span></i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="mso-bidi-font-weight: bold;">This is precisely what has happened at a policy level as evidenced by the following statements by former Cabinet Minister John Denham MP; <span style="mso-spacerun: yes;"> </span></span><i></i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><i>“All public services have to be based on a diversity of independent providers who compete for business in a market governed by Consumer choice. All across Whitehall, any policy option now has to be dressed up as “choice”, “diversity”, and “contestablity”. These are the hallmarks of the “new model public service”</i><sup><span style="mso-bidi-font-weight: bold;">22</span></sup></div><div class="Default" style="margin: 0cm 0cm 0pt;"><span style="mso-bidi-font-weight: bold;">and former Prime Minister, Tony Blair in his speech to the Public Services summit in 2004:</span><i></i></div><div class="Default" style="margin: 0cm 0cm 0pt;"><i>“It is only by transferring power to the public through choice, through personalising services, that we can create the drivers for continuous improvement in all our services.”</i><sup><span style="mso-bidi-font-style: italic;">23 </span></sup></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><b><span style="mso-tab-count: 1;"> </span></b><span style="mso-spacerun: yes;"> </span></div><div class="Default" style="margin: 0cm 0cm 0pt;"><span style="color: windowtext; mso-fareast-language: EN-US;">The influence of </span>public choice theory was a major factor in the rise of New Public Management (NPM) in the NHS (e.g the <i>Griffiths Report, </i>1983), which favours narrow economic priorities and micro-management practices (e.g performance indicators, league tables, monitoring and centrally imposed targets) over professional judgment<sup>24</sup>.<span style="mso-spacerun: yes;"> </span>Furthermore, relationships between medical professionals and patients depend on trust rather than contractual obligations and attempting to reduce the provision of healthcare to economic transactions erodes the intrinsic motivations on which the doctor-patient relationships depend<sup>25</sup>. </div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;">This strikes right at the heart of the social contract, which is fundamental to medical practice and professionalism. As Professor Kenneth Arrow recently stated about markets in healthcare<i style="mso-bidi-font-style: normal;"> “one problem we have now, is an erosion of professional standards”</i><sup> 26</sup><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-language: EN-GB;"></span></i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;">It is therefore no coincidence that the American medical profession lost public support faster than any other profession during the rapid marketisation of the US healthcare system in the 1970/80s. <sup>27</sup> </div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;">Another reason why medical professionalism is under threat is because it actually presents an obstacle to market reforms because doctors, especially GPs as the “gatekeepers”, control access to the healthcare system and exert control over the market through a combination of cultural authority on patients and political influence over policy making<sup>28</sup>. Doctors generally refer their patients to local services and prefer to work collaboratively to ensure the health needs of the local community are met. This form of collaboration is fundamentally anti-competitive in nature, and Professor David Marquand was therefore correct when he stated that public service professionals “<i style="mso-bidi-font-style: normal;">are in a profound sense not just non-market, but anti-market</i>” <a href="about:blank" name="OLE_LINK40"><sup>29</sup></a>.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">This clearly leaves Mr Lansley with a huge problem with his reform agenda because as he stated in a speech to the NHS confederation: <i style="mso-bidi-font-style: normal;"><span style="mso-fareast-language: EN-GB;">“the first guiding principle is this: maximise competition…... which is the primary objective”</span></i><sup> 30</sup><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-language: EN-GB;"> </span></i><span style="mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-language: EN-GB;">He also made it clear in the same speech that the way to maximise competition is to maximise the numbers of purchasers and providers in the system. This explains the thinking behind the policies of Any Qualified Provider and patient held budgets, and also explains why GPs are being given £60 billion of the NHS budget:</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-language: EN-GB;">“The statutory formula should make clear that choice should be exercised by patients, or as close to the patient as possible, thereby maximising the number of purchasers and enhancing the prospects of competition, innovation and responsiveness to patients.”</span></i><sup> 30</sup><i style="mso-bidi-font-style: normal;"><span style="mso-fareast-language: EN-GB;"> </span></i><span style="mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-language: EN-GB;">Another serious problem for Mr Lansley is that it is now widely accepted that clinical leadership and clinical followership is crucial to successful healthcare reform</span><sup>31</sup><span style="mso-fareast-language: EN-GB;">, but this clearly </span>requires “buy in” from the profession, which relies on trust and a shared vision. <span style="mso-fareast-language: EN-GB;">However,</span> a recent MORI poll of BMA members commissioned by the BMA clearly showed that doctors overwhelmingly think that pro-competition market reforms will be detrimental to patient care and will fragment services.<sup>32 </sup>Since markets also undermine<span style="mso-spacerun: yes;"> </span>medical professionalism and the doctor patient relationship, Mr Lansley is hardly likely to gain much professional support for his reforms, which is precisely what we have been witnessing since the White Paper was published last year. In fact, New Labour’s market based reforms were also deeply unpopular and opposed by the BMA’s “Look After Our NHS campaign.”<sup> 33</sup> <span style="mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="mso-fareast-language: EN-GB;">The Colleges should also be very concerned about the effect of market reforms on medical training and standards. The profession has already suffered the Modernising Medical Careers (MMC) debacle, which can in part be explained by the influence of market based policies. MMC utilised a </span><span style="mso-bidi-font-weight: bold;">competency based tick box approach to training and it is important to note that </span>Competency Based Training (CBT) originated in the 1980s and was a politically driven movement with the aim of making national workforces more competitive in the global markets by focusing on discrete technical skills with an emphasis on outputs, performance assessment, and value for money<sup>34</sup>.<span style="mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;">Sir John Tooke’s report of MMC, Aspiring to Excellence, clearly highlighted MMC’s emphasis on achieving minimal standards rather than excellence<a href="about:blank" name="OLE_LINK48"></a><a href="about:blank" name="OLE_LINK47"><span style="mso-bookmark: OLE_LINK48;"><sup>35</sup></span></a>. A prescient editorial in the British Journal of General Practice described how the proposals for the establishment of PMETB:</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><i>“… are clearly intended to enable the Secretary of State of the day to direct that <span style="mso-bidi-font-weight: bold;">standards can be lowered </span>to meet the manpower demands of the NHS”</i> <sup>36</sup></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;">MMC was clearly designed to produce a “fit for purpose” medical workforce in the new healthcare market. For example, the Department of Health website stated that MMC:</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;">“<i style="mso-bidi-font-style: normal;">Focuses on the development of a flexible medical workforce....and....<span style="mso-bidi-font-style: italic;">most importantly, will deliver a modern training scheme and career structure that will allow clinical professionals to support real patient choice”</span></i><sup> <a href="about:blank" name="OLE_LINK54"></a><a href="about:blank" name="OLE_LINK53"><span style="mso-bookmark: OLE_LINK54;">37</span></a></sup><span style="mso-bookmark: OLE_LINK54;"></span><span style="mso-bookmark: OLE_LINK53;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><u>Conclusion</u></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;">The Health and Social Care Bill builds on the market based policies of previous Governments, and poses an enormous threat to the NHS, medical professionalism, the doctor patient relationship, and ultimately patient care.<span style="mso-spacerun: yes;"> </span>It will put an end to the English NHS as a publicly funded, publicly provided, publicly accountable health service, which has served us so well for over 60 years and continues to do so<sup>38</sup>. These reforms are not just another episodic tinkering with the NHS, because independent expert legal opinion indicates that they will increase the likelihood of EU competition law being applied, which will effectively result in irreversible market based changes to the NHS.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><br />
So it is now more crucial than ever for the leaders of the Royal Colleges to join in with the chorus of opposition to the reforms to prevent the further marketisation and privatisation of the English NHS, which will be inevitable if the bill is enacted.<span style="mso-spacerun: yes;"> </span>The bill cannot pass without the support of the medical profession. The Colleges have a rare opportunity to make a stand for the NHS, the medical profession, and patients. We therefore call upon the Academy of Medical Royal Colleges to act in the public interest by publicly calling for the withdrawal of the Health and Social Care Bill.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-fareast-language: EN-GB;">Finally, we would like to state that we acknowledge that the NHS is not perfect and that we favour its vigorous evolutionary development. The NHS has undergone constant change since its inception and this will clearly need to continue in order for the NHS to face up to the serious challenges of the future. However, this must involve meaningful discussion and consultation with all those who will be responsible for providing the service. It must involve full consideration of <span style="mso-bidi-font-weight: bold;">all options</span>, not least the benefits of following the rest of the UK in abandoning the purchaser provider split and other market based policies, and pursuing a professionally led, collaborative approach to healthcare delivery based on trust, accountability, and the highest professional and ethical standards.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><a href="about:blank" name="OLE_LINK2"></a><a href="about:blank" name="OLE_LINK1"><span style="mso-bookmark: OLE_LINK2;">We leave the College presidents to ponder the words of Arnold Relman, Professor Emeritus of Medicine and Social Medicine at Harvard Medical School and former editor of the NEJM, who recently lamented:</span></a></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="mso-bookmark: OLE_LINK1;"><span style="mso-bookmark: OLE_LINK2;">“<i style="mso-bidi-font-style: normal;">Medical professionalism cannot survive in the current commercialized health care market. The continued privatization of health care and the continued prevalence and intrusion of market forces in the practice of medicine will not only bankrupt the health care system, but also will inevitably undermine the ethical foundations of medical practice and dissolve the moral precepts that have historically defined the medical profession.”</i><sup> 39</sup><i style="mso-bidi-font-style: normal;"></i></span></span></div><span style="mso-bookmark: OLE_LINK2;"></span><span style="mso-bookmark: OLE_LINK1;"></span><br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="mso-fareast-language: EN-GB;">Yours sincerely,</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="mso-fareast-language: EN-GB;">Dr Clive Peedell MRCP FRCR</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="mso-fareast-language: EN-GB;">Consultant Clinical Oncologist</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="mso-fareast-language: EN-GB;">Co-chair of the NHSCA</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="mso-fareast-language: EN-GB;">Dr Jacky Davis FRCR</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="mso-fareast-language: EN-GB;">Consultant Radiologist</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="mso-fareast-language: EN-GB;">Co-chair of the NHSCA</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="mso-fareast-language: EN-GB;">Dr Peter Fisher FRCP</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="mso-fareast-language: EN-GB;">President of the NHSCA</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><a href="http://www.nhsca.org.uk/index.html"><span style="mso-fareast-language: EN-GB;"><span style="color: blue;">http://www.nhsca.org.uk/index.html</span></span></a><span style="mso-fareast-language: EN-GB;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><b style="mso-bidi-font-weight: normal;"><span style="mso-fareast-language: EN-GB;">References:</span></b></div><div class="MsoListParagraphCxSpFirst" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-indent: -18pt;"><a href="about:blank" name="OLE_LINK15"></a><a href="about:blank" name="OLE_LINK14"><span style="mso-bookmark: OLE_LINK15;"><span style="mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">1.<span style="font-family: 'Times New Roman';"> </span></span></span>Available @: </span></a><a href="http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_127443"><span style="color: blue;">http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_127443</span></a> accessed 1/9/11</div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-indent: -18pt;"><a href="about:blank" name="OLE_LINK17"></a><a href="about:blank" name="OLE_LINK16"><span style="mso-bookmark: OLE_LINK17;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"><span style="mso-list: Ignore;">2.<span style="font-family: 'Times New Roman';"> </span></span></span>Available @: </span></a><a href="http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_127719.pdf"><span style="mso-fareast-language: EN-GB;">http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_127719.pdf</span></a><span style="mso-fareast-language: EN-GB;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-indent: -18pt;"><a href="about:blank" name="OLE_LINK22"></a><a href="about:blank" name="OLE_LINK21"><span style="mso-bookmark: OLE_LINK22;"><span style="mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">3.<span style="font-family: 'Times New Roman';"> </span></span></span>Available @: </span></a><a href="http://www.bma.org.uk/healthcare_policy/nhs_white_paper/latestnhsreformstatement.jsp">http://www.bma.org.uk/healthcare_policy/nhs_white_paper/latestnhsreformstatement.jsp</a> accessed 1/9/11</div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span style="mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">4.<span style="font-family: 'Times New Roman';"> </span></span></span>“Health bill changes fail to win over GPs, RCGP survey finds”. Pulse. 21st July 2011Available @:</div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt;"><a href="http://www.pulsetoday.co.uk/newsarticle-content/-/article_display_list/12436518/health-bill-changes-fail-to-win-over-gps-rcgp-survey-finds"><span style="color: blue;">http://www.pulsetoday.co.uk/newsarticle-content/-/article_display_list/12436518/health-bill-changes-fail-to-win-over-gps-rcgp-survey-finds</span></a> </div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span style="mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">5.<span style="font-family: 'Times New Roman';"> </span></span></span>‘Sir Roger Boyle: “It’s horrific that the NHS’s future is threatened”’. The Independent. Tuesday 26<sup>th</sup> July 2011.</div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span style="mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">6.<span style="font-family: 'Times New Roman';"> </span></span></span>“A slice of Britain: Lib Dem guerrillas plot their next move”. The Independent . June 19<sup>th</sup> 2011. Available @: <a href="http://www.independent.co.uk/news/uk/politics/a-slice-of-britain-lib-dem-guerrillas-plot-their-next-move-2299731.html"><span style="color: blue;">http://www.independent.co.uk/news/uk/politics/a-slice-of-britain-lib-dem-guerrillas-plot-their-next-move-2299731.html</span></a> <span style="mso-spacerun: yes;"> </span>accessed 1/9/11</div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span style="mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">7.<span style="font-family: 'Times New Roman';"> </span></span></span>“Taxpayers will no longer 'bail out' failing NHS hospitals”. The Telegraph. 20/6/11. Available@: <a href="http://www.telegraph.co.uk/journalists/martin-beckford/8587176/Taxpayers-will-no-longer-bail-out-failing-NHS-hospitals.html"><span style="color: blue;">http://www.telegraph.co.uk/journalists/martin-beckford/8587176/Taxpayers-will-no-longer-bail-out-failing-NHS-hospitals.html</span></a> accessed 1/9/11</div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span style="mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">8.<span style="font-family: 'Times New Roman';"> </span></span></span>Shirley Williams’ speech to the NHS Confederation Conference. 8/7/11. Accessed: 1/9/11. <a href="http://www.libdems.org.uk/speeches_detail.aspx?title=Shirley_Williams%E2%80%99_speech_to_the_NHS_Confederation_Conference&pPK=fb31954a-12ee-4832-82f5-e61fa65ed5ea"><span style="color: blue;">http://www.libdems.org.uk/speeches_detail.aspx?title=Shirley_Williams%E2%80%99_speech_to_the_NHS_Confederation_Conference&pPK=fb31954a-12ee-4832-82f5-e61fa65ed5ea</span></a></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">9.<span style="font-family: 'Times New Roman';"> </span></span></span><a href="http://www.dutytoprovide.net/"><span lang="EN-US" style="mso-ansi-language: EN-US;">http://www.dutytoprovide.net/</span></a><span lang="EN-US" style="mso-ansi-language: EN-US;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span class="pop-slug"><span style="mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">10.<span style="font-family: 'Times New Roman';"> </span></span></span></span>Peedell C. Further privatisation is inevitable under the proposed NHS reforms. BMJ <span class="slug-pop-date">2011;</span> <span class="pop-slug">342:d2996</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span class="pop-slug"><span style="mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">11.<span style="font-family: 'Times New Roman';"> </span></span></span></span>Reynolds L. <span style="mso-bidi-font-weight: bold; mso-fareast-language: EN-GB; mso-font-kerning: 18.0pt;">For-profit companies will strip NHS assets under proposed reforms </span>BMJ <span class="slug-pop-date">2011;</span> <span class="pop-slug">342:d3760</span></div><div class="MsoListParagraphCxSpLast" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span style="mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">12.<span style="font-family: 'Times New Roman';"> </span></span></span><a href="http://www.conservatives.com/pdf/NHSautonomyandaccountability.pdf">http://www.conservatives.com/pdf/NHSautonomyandaccountability.pdf</a></div><ol start="13" style="margin-top: 0cm;" type="1"><li class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-list: l1 level1 lfo2; vertical-align: top;">HM Government. The coalition: our programme for government. Cabinet Office, 2010. <a href="http://www.cabinetoffice.gov.uk/media/409088/pfg_coalition.pdf"><span style="color: windowtext;">www.cabinetoffice.gov.uk/media/409088/pfg_coalition.pdf</span></a></li>
</ol><div class="MsoListParagraph" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span class="pop-slug"><span style="mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">14.<span style="font-family: 'Times New Roman';"> </span></span></span></span>Walshe K. <span style="mso-bidi-font-weight: bold; mso-font-kerning: 18.0pt;">Reorganisation of the NHS in England. Editorial. </span>BMJ <span class="slug-pop-date">2010;</span> <span class="pop-slug">341:c3843</span></div><ol start="15" style="margin-top: 0cm;" type="1"><li class="MsoNormal" style="color: #222222; margin: 0cm 0cm 0pt; mso-list: l1 level1 lfo2; vertical-align: top;">Lansley’s GP lottery. Public Finance.16/11/10 Available @<span style="color: windowtext;"> <a href="http://opinion.publicfinance.co.uk/2010/07/lansleys-gp-lottery-by-zack-cooper-and-john-van-reenen/"><span style="color: blue;">http://opinion.publicfinance.co.uk/2010/07/lansleys-gp-lottery-by-zack-cooper-and-john-van-reenen/</span></a></span></li>
<li class="MsoNormal" style="color: #222222; margin: 0cm 0cm 0pt; mso-list: l1 level1 lfo2; vertical-align: top;"><span style="color: windowtext;"><a href="http://www.bma.org.uk/about_bma/index.jsp"><span style="mso-fareast-language: EN-GB;"><span style="color: blue;">http://www.bma.org.uk/about_bma/index.jsp</span></span></a></span></li>
<li class="MsoNormal" style="color: #222222; margin: 0cm 0cm 0pt; mso-list: l1 level1 lfo2; vertical-align: top;"><span style="color: windowtext; mso-bidi-font-weight: bold; mso-fareast-language: EN-GB;">Evidence to Public Bill Committee<a href="about:blank" name="11062870000002"></a>. <span style="mso-bidi-font-style: italic;">Tuesday 28 June 2011</span></span>. <span style="mso-spacerun: yes;"> </span><a href="about:blank" name="11062870000003"></a>Available@: <span style="color: windowtext;"><a href="http://www.publications.parliament.uk/pa/cm201011/cmpublic/health/110628/pm/110628s01.htm">http://www.publications.parliament.uk/pa/cm201011/cmpublic/health/110628/pm/110628s01.htm</a></span></li>
<li class="MsoNormal" style="color: #222222; margin: 0cm 0cm 0pt; mso-list: l1 level1 lfo2; vertical-align: top;"><span style="color: windowtext; mso-fareast-language: EN-GB;">Personal correspondence with NHSCA, dated 17<sup>th</sup> August 2011</span></li>
</ol><div class="MsoListParagraphCxSpFirst" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"><span style="mso-list: Ignore;">19.<span style="font-family: 'Times New Roman';"> </span></span></span><a href="http://www.rcplondon.ac.uk/about/mission"><span style="mso-fareast-language: EN-GB;"><span style="color: blue;">http://www.rcplondon.ac.uk/about/mission</span></span></a><span style="mso-fareast-language: EN-GB;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-align: justify; text-indent: -18pt;"><span style="mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">20.<span style="font-family: 'Times New Roman';"> </span></span></span><span style="mso-fareast-language: EN-GB;">Lowe R. <span style="mso-bidi-font-style: italic;">The Welfare State in Britain since 1945. </span>Macmillan, Houndmills. 1993</span></div><div class="MsoListParagraphCxSpLast" style="margin: 0cm 0cm 0pt 36pt; mso-layout-grid-align: none; mso-list: l1 level1 lfo2; text-align: justify; text-indent: -18pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"><span style="mso-list: Ignore;">21.<span style="font-family: 'Times New Roman';"> </span></span></span><span style="mso-fareast-language: EN-GB;">Le Grand J. Knights, knaves or pawns? Human behaviour and social policy. <i style="mso-bidi-font-style: normal;">J Soc Policy</i> 1997;26:149–69</span></div><ol start="22" style="margin-top: 0cm;" type="1"><li class="MsoNormal" style="color: #222222; margin: 0cm 0cm 0pt; mso-list: l1 level1 lfo2; vertical-align: top;">Available @: <span style="color: windowtext;"><a href="http://www.chartist.org.uk/articles/labourmove/march06denham.htm">http://www.chartist.org.uk/articles/labourmove/march06denham.htm</a></span></li>
</ol><div class="MsoListParagraph" style="margin: 0cm 0cm 0pt 36pt; mso-layout-grid-align: none; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span style="color: black; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"><span style="mso-list: Ignore;">23.<span style="font-family: 'Times New Roman';"> </span></span></span><span style="color: black; mso-fareast-language: EN-GB;">Blair T. <i>We should not shy away from radical reform.</i> Speech to Guardian Public Services Summit, 29 January 2004. </span></div><ol start="24" style="margin-top: 0cm;" type="1"><li class="MsoNormal" style="color: #222222; margin: 0cm 0cm 0pt; mso-list: l1 level1 lfo2; vertical-align: top;"><span style="color: windowtext;">Bottery M. Education, policy and ethics. Continuum. New York, 2000</span></li>
<li class="MsoNormal" style="color: #222222; margin: 0cm 0cm 0pt; mso-list: l1 level1 lfo2; vertical-align: top;"><span style="color: windowtext;">Coates D. Reviving the Public: A New Governance and Management Model for Public Services. The Work Foundation. 2006}</span></li>
</ol><div class="Default" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span style="mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">26.<span style="font-family: 'Times New Roman';"> </span></span></span>Interview with Kenneth Arrow: <span class="date">The Atlantic Jul 28 2009. Available @: </span><a href="http://www.theatlantic.com/politics/archive/2009/07/an-interview-with-kenneth-arrow-part-two/22279/">http://www.theatlantic.com/politics/archive/2009/07/an-interview-with-kenneth-arrow-part-two/22279/</a></div><ol start="27" style="margin-top: 0cm;" type="1"><li class="MsoNormal" style="color: #222222; margin: 0cm 0cm 0pt; mso-list: l1 level1 lfo2; vertical-align: top;"><span style="color: windowtext; mso-fareast-language: EN-GB;">Blendon R. “The public’s view of the future of medical care” <i>JAMA </i>1988 259: 3587-3593</span></li>
</ol><div class="MsoListParagraphCxSpFirst" style="margin: 0cm 0cm 0pt 36pt; mso-layout-grid-align: none; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span style="mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-GB;"><span style="mso-list: Ignore;">28.<span style="font-family: 'Times New Roman';"> </span></span></span><span style="mso-fareast-language: EN-GB;">Starr P. The social transformation of American medicine. Basic Books, New York.1982</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-layout-grid-align: none; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span style="mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">29.<span style="font-family: 'Times New Roman';"> </span></span></span>Marquand D. Decline of the Public. Polity Press 2004</div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span style="mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">30.<span style="font-family: 'Times New Roman';"> </span></span></span>Lansley A. Extract from “The future of health and public service regulation” speech. 2005. Available @: <a href="http://www.andrewlansley.co.uk/newsevent.php?newseventid=21"><span style="color: blue;">www.andrewlansley.co.uk/newsevent.php?newseventid=21</span></a>. </div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span style="mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">31.<span style="font-family: 'Times New Roman';"> </span></span></span>Ham C. Engaging Doctors in Leadership. A review of the literature. Available @ <a href="http://www.hsmc.bham.ac.uk/work/pdfs/Engaging_Doctors_Review.pdf"><span style="color: blue;">http://www.hsmc.bham.ac.uk/work/pdfs/Engaging_Doctors_Review.pdf</span></a></div><div class="MsoListParagraphCxSpLast" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span style="mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">32.<span style="font-family: 'Times New Roman';"> </span></span></span>Available @: <a href="http://www.bma.org.uk/healthcare_policy/nhs_white_paper/moripoll2011members.jsp">http://www.bma.org.uk/healthcare_policy/nhs_white_paper/moripoll2011members.jsp</a></div><ol start="33" style="margin-top: 0cm;" type="1"><li class="MsoNormal" style="color: #222222; margin: 0cm 0cm 0pt; mso-list: l1 level1 lfo2; vertical-align: top;"><span style="color: windowtext;"><a href="http://www.lookafterournhs.org.uk/"><span style="color: blue;">http://www.lookafterournhs.org.uk/</span></a></span></li>
</ol><div class="MsoListParagraphCxSpFirst" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-align: justify; text-indent: -18pt;"><span style="mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">34.<span style="font-family: 'Times New Roman';"> </span></span></span>Department of Education. <span style="mso-bidi-font-style: italic;">Working together: education and training.</span> London: HMSO, 1986</div><div class="MsoListParagraphCxSpLast" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-align: justify; text-indent: -18pt;"><span style="mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">35.<span style="font-family: 'Times New Roman';"> </span></span></span>Tooke J. and others. Aspiring to Excellence.<span style="mso-spacerun: yes;"> </span>Findings and final recommendations of the independent enquiry into modernising medical careers. 2008.<span style="mso-spacerun: yes;"> </span>HMSO (The Tooke Report) Available @: <u>http://www.mmcinquiry.org.uk/</u></div><ol start="36" style="margin-top: 0cm;" type="1"><li class="MsoNormal" style="color: #222222; margin: 0cm 0cm 0pt; mso-list: l1 level1 lfo2; vertical-align: top;"><span style="color: windowtext;">Cox J. “The Medical Education Standards Board: castrating the Medical Royal Colleges? <i style="mso-bidi-font-style: normal;">BJGP</i> 2002. March; 179-180</span></li>
<li class="MsoNormal" style="color: #222222; margin: 0cm 0cm 0pt; mso-list: l1 level1 lfo2; vertical-align: top;"><span style="color: windowtext;">Department of Health website. Modernising Medical Careers. Available @ <a href="http://www.dh.gov.uk/en/Managingyourorganisation/Humanresourcesandtraining/Browsable/DH_5835992"><span style="color: windowtext;">http://www.dh.gov.uk/en/Managingyourorganisation/Humanresourcesandtraining/Browsable/DH_5835992</span></a></span></li>
<li class="MsoNormal" style="color: #222222; margin: 0cm 0cm 0pt; mso-list: l1 level1 lfo2; vertical-align: top;"><span style="color: windowtext;"><a href="http://www.bbc.co.uk/news/10375877"><span style="color: blue;">http://www.bbc.co.uk/news/10375877</span></a></span></li>
</ol><div class="MsoListParagraph" style="margin: 0cm 0cm 0pt 36pt; mso-layout-grid-align: none; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span style="mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">39.<span style="font-family: 'Times New Roman';"> </span></span></span><span style="mso-bidi-font-weight: bold; mso-font-kerning: 18.0pt;">Relman A S. Medical professionalism in a commercialized health care market </span>Cleveland Clinic Journal of Medicine<span class="slug-pub-date3"><strong> November 2008 </strong></span><span class="slug-vol">vol. 75 </span><span class="slug-issue">Suppl 6 </span><span class="slug-pages3"><strong>S33-S36</strong></span></div>Clive Peedellhttp://www.blogger.com/profile/14800348230625234141noreply@blogger.com2tag:blogger.com,1999:blog-3422931188472387286.post-58687860459685338732012-01-21T19:08:00.001+00:002012-01-22T15:51:09.038+00:00The NHS is in the hands of the Medical Royal Colleges<div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="font-size: large;">The NHS is in the hands of the Medical Royal Colleges</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">The recent decision by the Royal College of Nursing (RCN) and the Royal College of Midwives (RCM) to come in line with the policy of the BMA to oppose the Health and Social Care Bill and call for its withdrawal, was a defining moment. Andrew Lansley’s <a href="http://digitalhen.co.uk/news/health-16618207">desperate attempts</a> to claim that this was all political and related to the ongoing pensions saga clearly highlighted how serious a blow this was to his plans. This was further emphasised by the offering of further concessions on the bill as reported in the Health Service Journal.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">The announcements by the RCN and the RCM were also a defining moment for the Medical Royal Colleges, who are represented by the umbrella organisation, <a href="http://aomrc.org.uk/">Academy of Medical Royal Colleges</a> (AoMRC), chaired by Professor Sir Neil Douglas.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">Suddenly, the Medical Royal Colleges find themselves in a position where they are the key players in the future passage of this bill and the future of the NHS. <span style="mso-spacerun: yes;"> </span>They are the last remaining big players representing frontline NHS professionals who remain on the fence regarding the bill. They represent the frayed fibres of a damaged rope rubbing against a rock, which Lansley is desperately clinging to for survival, as he hangs over a cliff edge. If the Colleges came out against the bill, then those final fibres would finally be severed and Lansley and his bill would fall. Even though the Government has a majority in both Houses, their public credibility would be shot to pieces if they went against a united professional coalition of the BMA, RCN, RCM, Unison, Unite and the AoMRC. It is inconceivable that the coalition would try to enact such a flawed bill against such powerful professional opposition, whilst simultaneously holding back the Risk Register. It would be a PR disaster of the highest order.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">In addition, one of Lansley’s three key stated principles underpinning his reforms is <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">“empowering frontline health professionals”.</i></b> United opposition from the medical and nursing professions would make a mockery of this claim, sending a clear public message of distrust in Mr Lansely and his bill.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">So the future of the NHS really does lie in the hands of the Medical Royal Colleges – and they know it. Following the RCN and RCM announcement, my own College (the Royal College of Radiologists) sent out an unprecedented urgent e-bulletin about the Health and Social Care Bill. In the bulletin, the RCR President, Dr Jane Barrett, stated:</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;">“Next week could be a defining period for the Colleges’ views on the Health and Social Care Bill”</i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">This refers to a number of meetings that will be going on behind the scenes next week.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">The Colleges must act during this crucial week, and they must act in the interests of their members and fellows, which means calling for the withdrawal of this highly unpopular, ideological and flawed bill. They have not acted in this way to date, and they cannot continue to use the excuse that they are apolitical to remain on the fence. After all, the President of the Royal College of Paediatrics and Child Health, Professor Terence Stephenson, is a member of the Government appointed <a href="http://healthandcare.dh.gov.uk/forum-members/">Future Forum</a>. Furthermore, the Chairman of the AoMRC, Prof Sir Neil Douglas has already <a href="http://www.publications.parliament.uk/pa/cm201011/cmpublic/health/110628/pm/110628s01.htm">given evidence to the Bill scrutiny committee</a> and stated that: </div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i>“...there are so many disadvantages in delaying that we have to get on with it to the best of our ability now. We will not be able to give you definitive answers on detailed questions because our members have not had a chance to respond, but we will do our best and we believe that we should be going forward at the moment.”</i> </div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">And Norman Williams of the Royal College of Surgeons has stated (without a mandate from his fellows) that the:</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i>“College largely supports the aims of the reforms to modernise the healthcare system.”</i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">In addition, the Government’s <a href="http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_127719.pdf">response to the Future Forum report</a> secures a number of important roles for the Colleges in delivering and leading the reforms. These roles include the establishment of close links with the NHS Commissioning Board (para 3.55), involvement in identifying the procedures most at risk of cherry picking (para 5.42) and prioritising work on Payment by Results (para 5.42) </div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">Just as the Government has no mandate from the electorate to push through this bill, the Royal Colleges have no mandate from their Members and Fellows to help deliver and lead the reforms. In fact, there is a solid argument that they have a clear mandate to oppose the bill, because the majority of members and fellows of Colleges are also members of the BMA, which has been mandated to oppose the bill and call for its withdrawal by its members. It is also unacceptable that the Colleges (with the notable exceptions of the RCGP and RCPsych) have not even surveyed the opinions of their members/fellows on such an important issue.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">The Colleges had already been warned about the bill in an <a href="http://www.nhsca.org.uk/docs/nhscarcp.pdf">open letter</a> from myself and well over <a href="http://www.nhsca.org.uk/docs/nhscasig.pdf">100 high profile co-signatories</a>. They failed to act decisively at that point. They have another chance and they must take it. Otherwise they could end up sharing the same legacy as the Liberal Democrats in colluding with a bill that will see the demise of the NHS.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">All doctors who belong to Colleges and want this bill withdrawn must now write to their Presidents ASAP. They must be made to feel the strength of opinion that is out there on the frontline. <span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">The other fundamentally important point is that the organisations calling for withdrawal of the bill should not back down, even if Lansley offers “significant” concessions. He is simply not to be trusted. He is after all a man who has said there would be “no top down reorganisations” and “no NHS privatisation”. The bill is far too complex and there is too little time to properly assess the impact of any new concessions. For example, the independent legal opinion on the Secretary of State’s duties and powers took weeks to put together. At this late stage, the only safe option for the NHS is for the bill to be withdrawn.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">We can will this battle, but we must stand firm.<br />
<br />
If you are a doctor, please lobby your college <a href="http://callonyourcollege.blogspot.com/">here</a></div>Clive Peedellhttp://www.blogger.com/profile/14800348230625234141noreply@blogger.com5tag:blogger.com,1999:blog-3422931188472387286.post-87161996910898517972012-01-17T08:32:00.001+00:002012-01-17T08:33:34.936+00:00"Let's be 'avin' you!"<div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="font-size: large;">Bevan’s Runners message to NHS and health leaders - “Let’s be ‘avin you”</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">The last day of Bevan’s Run started just after 8am on a frosty morning in Beaconsfield, with the aim of doing a 6 hour marathon to get into Whitehall by about 2pm.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">At Uxbridge we were joined <a href="about:blank" name="OLE_LINK2"></a><a href="about:blank" name="OLE_LINK1"><span style="mso-bookmark: OLE_LINK2;">by “Dave the Ambulance Man”, </span></a>who had come all the way from Bognor to do the last 18 miles with us. He is a member of the GMB union and you’ve guessed it - an Ambulance driver! He was very concerned about the bill and its negative effects on the NHS and local services. He said he was frustrated by the unions and was looking for leadership so he could do more to fight the bill. I shared those frustrations when thinking of the medical leaders from the Royal Colleges (with the exception of Clare Gerada from the Royal College of GPs). We felt that the unions and colleges had failed to show the leadership that grassroots members were yearning for to help fight against the bill. There had been too much focus on a “staying in the tent” approach with an associated complicity, which becomes counter-productive when dealing with such ideologically driven proposed legislation. Any form of support for such an unpopular bill is <a href="http://bevansrun.blogspot.com/2011/12/how-lansley-duped-professions-into.html">seized upon by the politicians</a> and their media machine, to drive the agenda forward.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">I told <span style="mso-spacerun: yes;"> </span>“Dave the Ambulance Man” about my recent <a href="http://www.nhsca.org.uk/docs/nhscarcp.pdf">open letter to the Royal College Presidents</a> (co-signed by <a href="http://www.nhsca.org.uk/docs/nhscasig.pdf">over 10<span style="mso-bookmark: OLE_LINK4;"><span style="mso-bookmark: OLE_LINK3;">0 doctors</span></span><span style="mso-bookmark: OLE_LINK4;"><span style="mso-bookmark: OLE_LINK3;"></span></span></a><a href="about:blank" name="OLE_LINK3"></a><a href="about:blank" name="OLE_LINK4"></a><span style="mso-bookmark: OLE_LINK4;"><span style="mso-bookmark: OLE_LINK3;">) calling for t</span></span>he Colleges to act in a united front against the bill. They did make a response, but it was a weak response and fell well short of agreeing with BMA policy, which is to call for withdrawal of the bill and to oppose it in its entirety. <span style="mso-spacerun: yes;"> </span>This is particularly frustrating because the BMA represents about 70% of all doctors, so will also represent the majority of College members and fellows too.<span style="mso-spacerun: yes;"> </span>I believe that it is disgraceful that the Colleges, (bar a couple of exceptions like the RCGP and RCPsych) have failed to survey the opinions and views of their paying members/fellows on such an important issue – an issue that resulted in the BMA calling for<span style="mso-spacerun: yes;"> </span>its first emergency Special Representative Meeting (SRM) to debate the bill in 20 years.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">Not only did “Dave the Ambulance Man” help me through “the wall” with a very well timed bag of “Skittles”, he also gave me the impetus to once again challenge the Colleges to come out much more actively against the bill. In addition, it also became clear that the leaders of other health unions, like the Royal College of Nursing (RCN), Unite and Unison, also need to show greater leadership to their members and show a lot more fight to defend the NHS. Their campaigns and public statements have not been big or bold enough thus far. </div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">“Bevan’s Run” may now be over, but our fight to defend the NHS and try and stop the Health and Social Care Bill must go on. The NHS is too important to be destroyed by such a flawed, undemocratic and ideologically driven bill. </div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">So the Bevan’s Runners message to Professor Neil Douglas, President of the Academy of Medical Royal Colleges; Dave Prentis and Karen Jennings of Unison; Len McClusky of Unite; and Peter Carter of the RCN is:</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;"><span style="font-size: large;"><strong>“Cahm on. Let’s be ‘avin’ you”</strong></span></i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">Dave the Ambulance man, a million NHS workers and many millions more members of the public, need you to stand with the NHS Consultants’ Association, BMA and the Royal College of GPs to call for withdrawal of the bill and organise a huge public rally in defence of the NHS. It is in the national interest for you to do this.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">So do it together and do it now. </div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
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</div>Clive Peedellhttp://www.blogger.com/profile/14800348230625234141noreply@blogger.com1tag:blogger.com,1999:blog-3422931188472387286.post-10350511212971851222012-01-14T19:01:00.002+00:002012-01-14T19:23:07.103+00:00Final day Details for Bevan's Run<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">We have now completed 5 days of Bevan's Run after a tough 25 mile slog from Wheatley to Beaconsfield. The initial plan was to stop at High Wycombe, but we took a decision 2 days ago to push onto to Beaconsfield in order to make the last day more manageable in terms of timings of arrivals at the Department of Health.<br />
<br />
On the final day of Bevan’s run on Sunday 15<sup>th</sup> January, we will be setting out from the <a href="http://www.travelodge.co.uk/hotels/info?hotelId=442">Travelodge hotel</a> in Beaconsfield at 7.30am.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">Anyone that wants to join us should meet in hotel lobby at 7.20am at latest.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">We will be running to Central London via Uxbridge and will follow the A4020 Uxbridge Road to Shepherd’s Bush and the join the A402 Baywater Road, running to Hyde Park on the northern side. We would welcome Hyde Park runners to join us anywhere along Bayswater road by Hyde Park (ETA approx 2pm, but subject to variation! Speakers Corner would be good place). We can also meet people in Uxbridge, who are keen to run a bit further. A good meeting place would be on Hillingdon Road next to the Cemetry, adjacent to Brunel University).<br />
<br />
I will be tweeting all day regarding our location.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">We will then head towards Whitehall via Park Lane, Constitution Hill, Birdcage Walk, Great George Street, and finally onto Parliament Street and Richmond House.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">Dr David Wilson and I will then deliver “Bevan’s Postcard” to the Department Health.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">This will be followed by short speeches from myself, Professor Ian Banks (President of European Men’s Health Forum, BMA Council), Dr David Wrigley (GP from Lancashire, BMA Council), Dr Jacky Davis (co-chair NHS Consultants’ Association, BMA Council), Dr Lucy Reynolds (Research fellow LSHTM) and Professor Allyson Pollock (Queen Mary, University of London). I hope to also have an important mystery guest speaker (TBC)</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">Finally, David and I will run the short distance to Downing Street, to deliver another “Bevan’s postcard” to No 10. (Permission requested)</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">Hopefully, the following Monday morning Mr Lansley and Mr Cameron will then withdraw the Health and Social Care Bill!</div>Clive Peedellhttp://www.blogger.com/profile/14800348230625234141noreply@blogger.com4tag:blogger.com,1999:blog-3422931188472387286.post-48328910508108517262012-01-13T08:17:00.000+00:002012-01-13T08:17:18.172+00:00Why Mr Cameron and Mr Lansley cannot be trusted to look after the NHS<div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="font-size: large;">Why Mr Cameron and Mr Lansley cannot be trusted to look after the NHS</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">The Prime Minister takes ultimate responsibility for Government policy and hence ultimate responsibility for looking after the NHS. In fact, Mr Cameron has clearly stated his commitment to the NHS on several occasions. In 2009, in <a href="http://www.telegraph.co.uk/news/politics/6060421/David-Cameron-the-NHS-is-safe-under-the-Conservatives.html">a speech in Bolton</a>, Mr Cameron claimed the NHS was safe under the Tories. </div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">However, in the same speech he also stated that:</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;">“</i><i style="mso-bidi-font-style: normal;"><span lang="EN" style="mso-ansi-language: EN;">Only a stable, transparent and pro-competitive framework will attract the independent sector to invest in and expand the capacity of the NHS”</span></i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;"><span lang="EN" style="mso-ansi-language: EN;">''By reducing political risk, we will open up the opportunity for any willing provider to supply care to NHS patients, accepting commercial risk, at NHS prices or less and at the right quality standards.''</span></i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span lang="EN" style="mso-ansi-language: EN;">Mr Cameron also said that <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">greater competition</i></b> within the NHS was the key to enhanced patient choice</span></div><span lang="EN" style="mso-ansi-language: EN;">These statements clearly show the underlying ideology that has been driving Mr Cameron and Mr Lansley – a competitive healthcare market with price competition. We have clearly seen this in the <a href="http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_117794.pdf">White Paper</a> and it will still be part of the legislation, despite all the rhethoric for "integrated" care (with its many potential meanings). The fact remains that all the tools are in place for a competitve external economic market (a third of the bill legislates for this)</span><br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span lang="EN" style="mso-ansi-language: EN;">All the key levers are in place to make this happen. All the suggestions from the Future Forum has done nothing to address the key market levers and reduce the risk of increasing marketisation and privatisation: </span></div><div class="MsoListParagraphCxSpFirst" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span lang="EN" style="mso-ansi-language: EN; mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">1.<span style="font: 7pt 'Times New Roman';"> </span></span></span><span lang="EN" style="mso-ansi-language: EN;">Patient choice to drive,</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span lang="EN" style="mso-ansi-language: EN; mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">2.<span style="font: 7pt 'Times New Roman';"> </span></span></span><span lang="EN" style="mso-ansi-language: EN;">competition between a plurality of providers through the Any Qualified Provider policy (which aims to introduce private sector companies)</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span lang="EN" style="mso-ansi-language: EN; mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">3.<span style="font: 7pt 'Times New Roman';"> </span></span></span><span lang="EN" style="mso-ansi-language: EN;">Payment by results (mony follows patients)</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span lang="EN" style="mso-ansi-language: EN; mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">4.<span style="font: 7pt 'Times New Roman';"> </span></span></span><span lang="EN" style="mso-ansi-language: EN;">Patient held budgets (increases consumersist approach for market)</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span lang="EN" style="mso-ansi-language: EN; mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">5.<span style="font: 7pt 'Times New Roman';"> </span></span></span><span lang="EN" style="mso-ansi-language: EN;">Price competition – yes it is back, despite the claims otherwise.</span></div><div class="MsoListParagraphCxSpLast" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo2; text-indent: -18pt;"><span lang="EN" style="mso-ansi-language: EN; mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">6.<span style="font: 7pt 'Times New Roman';"> </span></span></span><span lang="EN" style="mso-ansi-language: EN;">“Abdication” of Secretary of State’s duties and responsibilities to provide comprehensive healthcare services to the population.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span lang="EN" style="mso-ansi-language: EN;">The fact that price competition (ability to vary pricing/tariffs) is back on the agenda is clear evidence of the pro-market ideology of the coalition. It is a clear indication that Cameron and Lansley are driven by ideology not evidence. In fact, there is </span><span style="mso-bidi-font-weight: bold;">widespread recognition that price competition worsens healthcare outcomes.</span> According to Zack Cooper from the London School of Economics:<i style="mso-bidi-font-style: normal;"> “<a href="http://www.hsj.co.uk/news/finance/price-competition-could-raise-death-rates-experts-warn/5023349.article"><span style="color: blue;">Every shred of evidence suggests that price competition in healthcare makes things worse, not better</span></a>.”</i></div><div style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;">The <a href="http://www.nhsconfed.org/Documents/Response%20to%20Regulating%20healthcare%20providers%20FINAL.pdf"><span style="color: blue;">NHS Confederation also shares this view</span></a>:</div><div style="margin: 0cm 0cm 0pt; vertical-align: baseline;"><i style="mso-bidi-font-style: normal;">“Economic theory predicts that price competition is likely to lead to declining quality where (as in healthcare) quality is harder to observe than price. Evidence from price competition in the 1990s internal market and in cost constrained markets in the US [United States] confirms this, with falling prices and reduced quality, particularly in harder to observe measures.”</i></div><div class="MsoNormal" style="margin: 12pt 0cm 0pt;"><span lang="EN" style="mso-ansi-language: EN;">The ideological rather than evidence based nature of the reforms is one of the key reasons why the official BMA policy position is to oppose the bill in its entirety, as well as calling for the bill to be withdrawn. Seven former Presidents of the UK Public Health Faculty agreed with the BMA position in a recent letter to the Times. And the recent RCGP survey showed 98% of GPs want the bill withdrawn and they are supposed to be leading the reforms. Since Chris Ham’s research has concluded that <a href="http://bevansrun.blogspot.com/2011/12/why-lansleys-market-driven-reforms-are.html">clinical leadership is crucial to successful healthcare reforms</a>, this creates huge problems for Mr Cameron and Mr Lansley. They need to drop the bill right now.</span></div><div class="MsoNormal" style="margin: 12pt 0cm 0pt;"><span lang="EN" style="mso-ansi-language: EN;">The game is up for Mr Cameron and Mr Lansley. The health professions have lost faith in them a long time ago. We don’t believe the spin and the rhetoric. Here are plenty more examples:</span></div><div class="MsoNormal" style="margin: 12pt 0cm 0pt;"><span lang="EN" style="mso-ansi-language: EN;"><span style="mso-spacerun: yes;"> </span>The </span>2010 Conservative Election Manifesto: <i>“More than three years ago, David Cameron spelled out his priorities in three letters – NHS”</i> <span lang="EN" style="mso-ansi-language: EN;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">This refers to “<i><a href="http://www.conservatives.com/pdf/NHSautonomyandaccountability.pdf">NHS Autonomy and Accountablility</a>. Proposals for legislation</i>” (2007) </div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">The Introduction written by Cameron and Lansley :</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">“<i>Improving the NHS is the Conservative Party’s <b>number one priority</b>....<b>this requires an end to the pointless upheavals</b>, politically-motivated cuts, increased bureaucracy and greater centralisation that have taken place under Labour..”</i> </div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">David Cameron’s speech at the 2006 Conservative party conference:</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">“<i><span style="mso-bidi-font-weight: bold;">no more pointless and disruptive reorganisations</span></i>”. Instead, change would be <i>“<span style="mso-bidi-font-weight: bold;">driven by the wishes and needs of NHS professionals and patients”. </span></i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">The Coalition agreement also specifically pledged to "<i>stop the top-down reorganisations of the NHS that have got in the way of patient care</i>“ (HM Government. <a href="http://www.cabinetoffice.gov.uk/sites/default/files/resources/coalition_programme_for_government.pdf">The Coalition: Our Programme for Government</a>. Cabinet Office, 2010.)</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">The Conservative 2007 White Paper would have been in keeping with their claims because of the following statements:</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18pt;"><span style="font-family: 'Arial','sans-serif'; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">•<span style="font: 7pt 'Times New Roman';"> </span></span></span>4.25 “As part of our commitment to avoid organisational upheaval, we will retain England’s ten SHAs, which will report to the NHS Board.”</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18pt;"><span style="font-family: 'Arial','sans-serif'; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">•<span style="font: 7pt 'Times New Roman';"> </span></span></span>4.28 “PCTs will remain local commissioning bodies.”</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">However, the current bill abolishes these structures, so this is clearly a top down reorganisation of the NHS! The coalition have mislead the public</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">Hence according to Andrew George, Liberal Democrat MP, of the Health Select Committee </div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">Lansley had "<i>Torn up the agreement to resist imposing a top-down re-organisation</i>“ </div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">And Zack Cooper of the LSE:</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">“<i>The new health secretary campaigned on a pledge to eliminate top-down shake ups of the health service. This white paper contradicts his campaign promise</i>” </div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">Worse still the estimated costs of reorganisation are £3 billion! (<a href="http://www.guardian.co.uk/politics/2010/jul/16/nhs-reorganisation-patient-care-bmj"><span style="color: blue;">Walshe BMJ</span></a>)</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><b style="mso-bidi-font-weight: normal;">The bottom line</b></div><em><span style="color: #333333;">“The White Paper’s proposals are ideological with little evidential foundation. They represent a decisive step towards privatisation that risks undermining the fundamental equity and efficiency objectives of the NHS. Rather than “liberating the NHS”, these proposals seem to be an exercise in liberating the NHS’s £100 billion budget to commercial enterprises” </span></em><span style="color: #333333;"><a href="http://www.marmotreview.org/AssetLibrary/resources/external%20reports%20from%20consultation/wp%20comment%20lancet.pdf" target="_blank"><span style="color: blue;">Lancet Oct 6th 2010</span></a></span><br />
<span style="color: #333333;">The simple fact is that Mr Cameron and Mr Lansley cannot be trusted on the NHS. Their ideology is neoliberal, with an uncritical faith in markets and the drive for a minimal welfare safety net. It is clear in their policies. This is why they want to privatise large swathes of the NHS. There is no democratice legitimacy for this approach. We must therefore fight them tooth and nail to stop this bill becoming law, and that is why I’ll be in Witney today to tell Mr Cameron’s constituents what he is up to. <span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span><br />
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</div>Clive Peedellhttp://www.blogger.com/profile/14800348230625234141noreply@blogger.com1tag:blogger.com,1999:blog-3422931188472387286.post-30196509090490107112012-01-12T19:25:00.000+00:002012-01-12T19:25:58.203+00:00Bevan’s run – Day 3: Tetbury to Burford.<div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i style="mso-bidi-font-style: normal;"><span style="font-size: 14pt;">Posted by Dr David Wilson, Bevan’s Runner. </span></i></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">OUCH! Today was painful.</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">We have now been joined by Dr Chris Burns-Cox (see pic below - Chris is old boy in background!), our support team driver, who has made an anti-bill sign for the roof of his car from the headboard of his parent’s bed. We left The Ormond Hotel, Tetbury (which is fantastic, by the way and well worth a visit) and ran to Cirencester. Clive was in pain with his left knee pretty much from the start, but somehow managed to make it with a concoction of sprays and painkilling drugs - a sort of dodgy from of chemotherapy. </div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_SR0JFzowbCX1nT_avxrKP9NPty20DUSEey8ShRy2_O0cd16u4zwieELzQ85gefb6DTqYmEoz96CpBrwgDh-mYXJlr-NKACw4_F-E_B9alihwPsxnrm8iqe4P1kPJtlh5Vfy2aPcsjr8/s1600/dp-bevansrun004.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="212px" kba="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_SR0JFzowbCX1nT_avxrKP9NPty20DUSEey8ShRy2_O0cd16u4zwieELzQ85gefb6DTqYmEoz96CpBrwgDh-mYXJlr-NKACw4_F-E_B9alihwPsxnrm8iqe4P1kPJtlh5Vfy2aPcsjr8/s320/dp-bevansrun004.jpg" width="320px" /></a></div><div class="MsoNormal" style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; margin: 0cm 0cm 0pt;">Cirencester to Burford was a long and painful slog on heavy legs from the previous 70 miles. My thighs were burning badly by the time we reached Burford. However, we are here now, and after an ice bath (it’s better than it sounds, though I expect most of Burford heard the screams as I lowered myself into it), and a vigorous rub down with ibuprofen gel, the world is a much less painful place.</div><div class="MsoNormal" style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; margin: 0cm 0cm 0pt;">We heard today that a survey of 2,600 GPs has shown 98% of GPs want this bill withdrawn.</div><div class="MsoNormal" style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; margin: 0cm 0cm 0pt;">In addition, an <a href="http://abetternhs.wordpress.com/2012/01/12/ph/">influential group of public health</a> experts have made an urgent plea to all medical, nursing and allied health professional Royal Colleges and Faculties urging them to oppose the bill. <span style="mso-spacerun: yes;"> </span></div><div class="MsoNormal" style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; margin: 0cm 0cm 0pt;">It beggars belief that it is so close to being enacted. The politicians are just not listening.</div><div class="MsoNormal" style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">Clive will be posting something later toninght after he’s recovered a bit more!</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">If you haven’t already, please sign the <a href="http://epetitions.direct.gov.uk/petitions/22670">e-petition</a>. It is now being endorsed by Rio Ferdinand. It has attracted another 5,000 signatures in last 24hours! We need to get it to 100,000 </div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;">You can follow us on Twitter @cpeedell or @DrDavidCWilson</div>Clive Peedellhttp://www.blogger.com/profile/14800348230625234141noreply@blogger.com0tag:blogger.com,1999:blog-3422931188472387286.post-84139123895673438922012-01-11T19:34:00.001+00:002012-01-11T19:38:56.949+00:00Guest Blog: Competition in healthcare and the NHS<div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12pt; line-height: 115%;"><span style="font-family: Calibri;">COMPETITION IN HEALTHCARE AND IN THE NHS</span></span></b></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><span style="font-family: Calibri;">Dr Lucy Reynolds</span><br />
<span style="font-family: Calibri;">London School Hygiene and Tropical Medicne</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><span style="font-family: Calibri;">11 January 2012</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><span style="font-family: Calibri;">Andrew Lansley has made clear since 2005 that he intends radical change to the NHS, and that that reform will centre on introducing competition throughout the service</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><span style="font-family: Calibri;">WHY IS ANDREW LANSLEY SO FOCUSED ON INTRODUCING COMPETITION, AND WHY IS THERE SUCH OPPOSITION TO THE IDEA?</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><span style="font-family: Calibri;">This is because participation in a competitive market under competition and trade law can give private sector market participants legal rights to maintain that access on equal terms with all other providers, including private sector entities.<span style="mso-spacerun: yes;"> </span>Such rights are enforceable in the UK and EU courts and through WTO arbitration.<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><span style="font-family: Calibri;">The legal position on this is not at all clear, but there is certainly doubt about the possibility of going back on an NHS privatisation should it turn out that the country is after all not keen on having its health services organised to maximise profits rather than to meet the medical needs of its people. This uncertainty has been acknowledged in the House of Commons by ex-McKinsey man David Bennett, who heads Monitor (see Commons Hansard 28 June 2011).</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><span style="font-family: Calibri;">REASONS FROM ECONOMIC THEORY WHY COMPETITIVE MARKETS WILL MAKE THE NHS MORE EXPENSIVE AND LESS EFFECTIVE </span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><span style="font-family: Calibri;">There are several reasons other than its possible irrevocability why the using markets to organise health care is a bad idea, and an expensive option also.<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoListParagraphCxSpFirst" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l2 level1 lfo2; text-indent: -18pt;"><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">1.</span><span style="font-family: 'Times New Roman';"> </span></span></span><span style="font-family: Calibri;">First, the assumptions underlying the market model really don’t fit at all well. These include:</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 49.65pt; mso-add-space: auto; mso-list: l0 level1 lfo3; text-indent: -18pt;"><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font-family: 'Times New Roman';"> </span></span></span><span style="font-family: Calibri;">No barriers to market entry or exit: but doctors need to be trained for years and hospitals need expensive facilities which aren’t easily converted to alternative uses.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 49.65pt; mso-add-space: auto;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 49.65pt; mso-add-space: auto; mso-list: l0 level1 lfo3; text-indent: -18pt;"><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font-family: 'Times New Roman';"> </span></span></span><span style="font-family: Calibri;">Product homogeneity: but any clinician will tell you that for most conditions, there is great individual variation in the treatments needed for different patients, even those who have the same diagnosis.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 49.65pt; mso-add-space: auto;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 49.65pt; mso-add-space: auto; mso-list: l0 level1 lfo3; text-indent: -18pt;"><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font-family: 'Times New Roman';"> </span></span></span><span style="font-family: Calibri;">No transaction costs, meaning no costs to provider or patient of getting to the point where a treatment is sold: but clearly either the patient must visit the doctor or vice versa, and the costs of consultations and diagnostic tests are well above zero.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 49.65pt; mso-add-space: auto;"><br />
</div><div class="MsoListParagraphCxSpLast" style="margin: 0cm 0cm 10pt 49.65pt; mso-add-space: auto; mso-list: l0 level1 lfo3; text-indent: -18pt;"><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font-family: 'Times New Roman';"> </span></span></span><span style="font-family: Calibri;">Perfect information about the healthcare transaction between doctor and patient so that they can strike a fair price for the services purchased: but of course patients don’t go to medical school or receive clinical training in hospitals so they often have very little comprehension of what is wrong with them. A substantial minority of people in this country believe in homeopathy, crystal healing and suchlike: they lack even a basic grasp of the science underlying medicine, so how can they be considered to have enough understanding to know if the doctor’s prescription is the best thing for them or whether it is based on the best interests of the hospital’s profit and loss account? </span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 10pt 1cm;"><span style="font-family: Calibri;">The most problematic of all of these is the information asymmetry between buyer and seller, because the new system gives a direct financial incentive for health care providers to exploit their superior medical knowledge to over-provide and also to overcharge for what they provide. There is a copious research literature showing what happens in this situation, based on both theory and practice: if you pay providers fees for the treatments they give, and allow them to keep any profits (and force them to suffer any financial losses) then you get what’s called supplier-induced demand.<span style="mso-spacerun: yes;"> </span>This means that the treatments given to a patient are more extensive than the patient’s medical condition warrants, and the charges per item also get pushed as high as the market will bear. Not only do patients get more treatment than they need (which can be dangerous after all – for instance there is a certain irreducible minimum of adverse reactions to anaesthetics, and these can be fatal), but the NHS budget will have to bear the cost of all this over-use and over-charging. And once patients understand that providers get paid more for over-treating them than for treating them correctly, the trust in doctors will be destroyed, leaving everyone worse off (except the litigators and the malpractice insurance companies!).</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt 1cm;"><span style="font-family: Calibri;">If any of these conditions are not fulfilled, the consequence is market failure. It is plain that markets in health care do not optimise health outcomes even in theory.<span style="mso-spacerun: yes;"> </span>It is equally plain that practice mirrors theory on this: we have examples of market-based systems, such those in the USA, China, and much of the developing world which produce a mismatch between care needed and care provided.<span style="mso-spacerun: yes;"> </span>We do not have any examples anywhere in the world of market-based healthcare systems which reliably produce healthcare which meets needs without wasting funds on overtreatment.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt 1cm;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l2 level1 lfo2; text-indent: -18pt;"><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">2.</span><span style="font-family: 'Times New Roman';"> </span></span></span><span style="font-family: Calibri;">The competitive market model requires that there always be a choice of provider offered.<span style="mso-spacerun: yes;"> </span>The new NHS operating framework sets targets for the proportion of non-NHS providers, in order to provide this choice.<span style="mso-spacerun: yes;"> </span>Since waiting lists were fairly stable and fairly short when this government took over the NHS, we can be confident that we already had about the right capacity to treat the number of unwell people in our population.<span style="mso-spacerun: yes;"> </span>So these extra providers will be adding capacity: indeed this redundant capacity is a necessary correlate of the market model, if patients are always to be offered the required choice of at least three providers.<span style="mso-spacerun: yes;"> </span>The NHS budget must, one way or another, cover the costs of having this redundant capacity provided only so that the market model may function.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l2 level1 lfo2; text-indent: -18pt;"><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">3.</span><span style="font-family: 'Times New Roman';"> </span></span></span><span style="font-family: Calibri;">The competitive market model requires that every transaction involving a patient must be billed.<span style="mso-spacerun: yes;"> </span>This results in a sizeable administration which is otherwise unnecessary.<span style="mso-spacerun: yes;"> </span>The NHS budget will have to foot this bill too if the reform goes through. </span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l2 level1 lfo2; text-indent: -18pt;"><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">4.</span><span style="font-family: 'Times New Roman';"> </span></span></span><span style="font-family: Calibri;">The Economist has recently pointed out a little remarked-upon correlate of competition, the need to advertise services so as to maximise market share.<span style="mso-spacerun: yes;"> </span>Marketing is not cheap: the design of advertisements uses costly professionals, and the purchase of media space in which to showcase services is also expensive.<span style="mso-spacerun: yes;"> </span>This expense will also soak up a sizeable share of the over-stretched NHS budget.</span></div><div class="MsoListParagraphCxSpLast" style="margin: 0cm 0cm 10pt 36pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><span style="font-family: Calibri;">Being an NHS patient is not much like being a consumer: it’s an intrinsically different type of transaction.<span style="mso-spacerun: yes;"> </span>Even being a private hospital patient paid for out of pocket is not much like buying consumer goods: someone with a serious illness does not have such a free choice of whether to spend money on treatment or some other goods or services, because actually the choice may be to buy the treatment or not buy anything at all, due to having deceased from the illness.<span style="mso-spacerun: yes;"> </span>The consumer-based market model simply does not fit any but the most trivial health care services.<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoListParagraph" style="margin: 0cm 0cm 10pt 1cm; mso-add-space: auto;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><span style="font-family: Calibri;">LACK OF EVIDENCE THAT COMPETITION BENFITS QUALITY IN HEALTH CARE</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><span style="font-family: Calibri;">On the other hand, there is no evidence whatsoever that competition in healthcare is beneficial.<span style="mso-spacerun: yes;"> </span>Even the zealots admit that competition on price has negative effects on quality, and a medical negligence QC, John Whitting</span><a href="http://www.blogger.com/post-create.g?blogID=3422931188472387286#_edn1" name="_ednref1" style="mso-endnote-id: edn1;" title=""><span class="MsoEndnoteReference"><span style="mso-special-character: footnote;"><span class="MsoEndnoteReference"><span style="font-family: 'Calibri','sans-serif'; font-size: 11pt; line-height: 115%; mso-ansi-language: EN-GB; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Times New Roman'; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[1]</span></span></span></span></a><span style="font-family: Calibri;"> pointed out last summer a specific way on which it causes quality to decline. He expects negligence cases to soar as a result of the roll-out of competitive commissioning:</span></div><div class="MsoNormal" style="margin: 0cm 26.05pt 10pt 1cm;"><i style="mso-bidi-font-style: normal;"><span style="font-family: Calibri;">“Even leaving aside the additional pressures on costs which apply uniquely to private healthcare organisations (the generation of profit and the payment of dividends to its shareholders), the need to undercut competitors in the NHS will inevitably impact on their primary item of expenditure: their staff. Fewer doctors and fewer nurses will have to work longer shifts: in other words, the very environment in which mistakes are most likely to happen......<span style="mso-spacerun: yes;"> </span>These proposals are patently driven by commercial imperatives rather than by consideration of patient wellbeing.”</span></i></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><span style="font-family: Calibri;">After a quarter of a century of unsubstantiated assertions that competition benefits quality in healthcare as long as it is not based on price competition, lobbyists finally, in 2010-11, found three UK-based studies which purport to test and prove this theory.<span style="mso-spacerun: yes;"> </span>They are known as the Cooper et al paper and the Propper et al studies. </span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><span style="font-family: Calibri;">As these authors could not measure competition in the NHS per se they used the density of service provision as a proxy, comparing it with routine health service data on heart attack mortality. These three papers stand against a background of many other studies which do not find a positive association (as noted in a review of the literature in one of them) and in contrast to the theoretical case for why market-based competition in healthcare would be harmful, as set out by the Nobel Laureate Kenneth Arrow. While the three papers contain elaborate mathematical models corrected for many relevant confounding factors including distance to hospital, they suffer from a basic scientific error, the confusion of association and causation: they document the former and impute the latter. A small but perceptible difference in the outcomes before and after the introduction of small-scale competition mechanisms in the NHS is present, but the authors do not offer any convincing mechanism for how reduction of heart attack mortality might result from higher hospital density (which, as noted, they treat as a proxy for greater market competition between providers). Instead they postulate a general “halo” effect of greater operational efficiency arising from bidding for some types of work in the same hospitals that treat heart attacks, via a more “competitive” culture. Alternative explanations for the outcomes generated from the models they have devised exist, such as under-correction for the time taken for ambulances to drive heart attack patients to the nearest hospital. They also ignore the possibility of “upcoding”, although this exaggeration of the gravity of illness in incoming patients is a well-known consequence of paying hospitals according to the quantity and type of cases they treat, a change which is part of the competitive internal market introduced in the NHS. If hospitals are judged on mortality and outcome data there is an incentive to record medical problems as more severe than they are, a practice that is hard to detect even by tracking back to case notes. For this overlooked explanation both motive and mechanism are evident, and so is much precedent. Even if there is a true effect, these studies provide no evidence that it was competition that brought it about: it could as easily have been due to other changes taking place at the same time. </span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><span style="font-family: Calibri;">None of these three papers actually provide any evidence that the market competition reform proposed will in any way improve the NHS, and the fact that they are persistently cited as the best proof available (even after their over-claims have been exposed in the BMJ and the Lancet) tells its own story.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><span style="font-family: Calibri;">CUI BONO?</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><span style="font-family: Calibri;">The reason this inappropriate arrangement is being forced on to the NHS is that some companies see profit opportunities in the change, for instance the German company Helios which has contracted to run 20 UK hospitals, the private equity-dominated Circle Health</span><a href="http://www.blogger.com/post-create.g?blogID=3422931188472387286#_edn2" name="_ednref2" style="mso-endnote-id: edn2;" title=""><span class="MsoEndnoteReference"><span style="mso-special-character: footnote;"><span class="MsoEndnoteReference"><span style="font-family: 'Calibri','sans-serif'; font-size: 11pt; line-height: 115%; mso-ansi-language: EN-GB; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Times New Roman'; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[2]</span></span></span></span></a><span style="font-family: Calibri;">, or the management consultancies which are lined up to support CCGs by selling the organisation of the technical side of commissioning to them.<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><span style="font-family: Calibri;">For their benefit we are giving up a national health service which is among the leaders in the world for health outcomes and among the most cost-effective developed world systems (Commonwealth Fund every year with 7-10 developed countries, Pritchard & Wallace 17-country comparison Journal RSM 2011).</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><span style="font-family: Calibri;">For their benefit, the government is proposing to arrange our healthcare so that a limited healthcare budget, under pressure from technological advances and an ageing population will be unnecessarily diverted in substantial part to (in no particular order):</span></div><div class="MsoListParagraphCxSpFirst" style="margin: 0cm 0cm 0pt 36pt; mso-list: l3 level1 lfo4; text-indent: -18pt;"><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: 'Times New Roman';"> </span></span></span><span style="font-family: Calibri;">Advertising agencies</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l3 level1 lfo4; text-indent: -18pt;"><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: 'Times New Roman';"> </span></span></span><span style="font-family: Calibri;">Media outlets which carry advertising</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l3 level1 lfo4; text-indent: -18pt;"><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: 'Times New Roman';"> </span></span></span><span style="font-family: Calibri;">Malpractice insurers</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l3 level1 lfo4; text-indent: -18pt;"><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: 'Times New Roman';"> </span></span></span><span style="font-family: Calibri;">Shareholders</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l3 level1 lfo4; text-indent: -18pt;"><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: 'Times New Roman';"> </span></span></span><span style="font-family: Calibri;">Retailers, wholesalers and producers of overprescribed pharmaceuticals and other products</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l3 level1 lfo4; text-indent: -18pt;"><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: 'Times New Roman';"> </span></span></span><span style="font-family: Calibri;">Having hospital capacity lying idle </span></div><div class="MsoListParagraphCxSpLast" style="margin: 0cm 0cm 10pt 36pt; mso-list: l3 level1 lfo4; text-indent: -18pt;"><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: 'Times New Roman';"> </span></span></span><span style="font-family: Calibri;">Unnecessary administration</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><span style="font-family: Calibri;">BETTER ALTERNATIVES TO COMPETITION-BASED PROVISION</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><span style="font-family: Calibri;">There are three very pertinent alternative models of how services can be arranged without competition.<span style="mso-spacerun: yes;"> </span>These are: </span></div><div class="MsoListParagraphCxSpFirst" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo1; text-indent: -18pt;"><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: 'Times New Roman';"> </span></span></span><span style="font-family: Calibri;">The arrangements in the UK NHS prior to the introduction of the internal market</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo1; text-indent: -18pt;"><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: 'Times New Roman';"> </span></span></span><span style="font-family: Calibri;">The arrangements in the Scottish NHS since they removed the purchaser-provider split</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l1 level1 lfo1; text-indent: -18pt;"><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: 'Times New Roman';"> </span></span></span><span style="font-family: Calibri;">The arrangements in the New Zealand national health system since they rolled back their internal market</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt; mso-add-space: auto;"><span style="font-family: Calibri;">Either would be viable, since both are home-grown and hence fully compatible with the NHS system.<span style="mso-spacerun: yes;"> </span>The Scottish model has received very favourable reports, and is clearly cheaper than the English system now that competition-based allocation has brought extra providers into the system, many of which must pay a proportion of the money they receive for service provision over to their shareholders. The New Zealand model also appears successful according to independent evaluations.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt; mso-add-space: auto;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt; mso-add-space: auto;"><span style="font-family: Calibri;">In these cases, mechanisms internal to the system arrange for the different parts of the system to work in synergy, without the need for redundant capacity. This rational planning system can fairly closely match the services provided to the profile of need in the population, so it does not suffer from the problems of the<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt; mso-add-space: auto;"><br />
</div><div class="MsoListParagraphCxSpLast" style="margin: 0cm 0cm 10pt; mso-add-space: auto;"><span style="font-family: Calibri;">Switching back to planning and away from markets in health care will certainly offend this government and the corporates that it has promised contracts to, but it can provide better value for money and a superior standard of care for the same budget. In these cost-conscious days, why is the government proposing to squander huge amounts of public money by reorganising the NHS in this much costlier and less effective way?</span></div><div style="mso-element: endnote-list;"><br />
<span style="font-family: Calibri;"></span><br />
<div id="edn1" style="mso-element: endnote;"><div class="MsoEndnoteText" style="margin: 0cm 0cm 0pt;"><a href="http://www.blogger.com/post-create.g?blogID=3422931188472387286#_ednref1" name="_edn1" style="mso-endnote-id: edn1;" title=""><span class="MsoEndnoteReference"><span style="mso-special-character: footnote;"><span class="MsoEndnoteReference"><span style="font-family: 'Calibri','sans-serif'; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-GB; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Times New Roman'; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[1]</span></span></span></span></a><span style="font-family: Calibri; font-size: x-small;"> http://www.newstatesman.com/blogs/the-staggers/2011/06/care-nhs-health-clinical</span></div></div><div id="edn2" style="mso-element: endnote;"><div class="MsoEndnoteText" style="margin: 0cm 0cm 0pt;"><a href="http://www.blogger.com/post-create.g?blogID=3422931188472387286#_ednref2" name="_edn2" style="mso-endnote-id: edn2;" title=""><span class="MsoEndnoteReference"><span style="mso-special-character: footnote;"><span class="MsoEndnoteReference"><span style="font-family: 'Calibri','sans-serif'; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-GB; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Times New Roman'; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[2]</span></span></span></span></a><span style="font-family: Calibri; font-size: x-small;"> Touted as “a John Lewis-style partnership”, this company is in fact majority owned by a group of three private equity companies which allegedly gave generously to Tory party funds, and is run by a formed merchant banker with Goldman Sachs.<span style="mso-spacerun: yes;"> </span>Its clinicians have just under half the shares, but the management control is with the money men, because of its majority voting system, and the fact that all but one of the directors are financial services specialists without health care experience. </span></div></div><br />
<hr align="left" size="1" width="33%" /></div>Clive Peedellhttp://www.blogger.com/profile/14800348230625234141noreply@blogger.com8tag:blogger.com,1999:blog-3422931188472387286.post-49282669922882428272012-01-10T02:07:00.003+00:002012-01-10T16:41:59.386+00:00Transcript of Bevan's Run speech<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">Transcript of speech at start of Bevan's Run, Cardiff (Jan 10th, 2012)</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-bookmark: OLE_LINK1;">“Nye Bevan’s original vision for the NHS was that all citizens should be protected from illness and pain, so that even the most disadvantaged in society would have “freedom from fear”. We cannot prevent the fear people feel when they actually fall ill, but we can prevent the fear of being unable to afford care and get access to care, by providing a comprehensive health service, free at the point of delivery, to all. This is what the NHS is all about and this is what needs protecting. It is the glue that holds our society together.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-bookmark: OLE_LINK1;"><br />
The Health and Social Care Bill will bring the fear back because its long term goal is to provide a minimal safety net rather than a comprehensive care service. That is why Lord Owen has called this bill, “the Secretary of State Abdication bill”. Mr Lansley wants to remove the duties and powers of the Secretary of State to provide a comprehensive health service to all citizens. This is a key reason why he needs new legislation to achieve his aims.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-bookmark: OLE_LINK1;">The bill will lead to increasing privatisation and commercialisation of healthcare provision which will create a fragmented and expensive service where money that could have been spent on frontline care will be funnelled into the pockets of private shareholders. The bill will undermine the public service ethos, erode medical professionalism, and damage the social contract of the doctor- patient relationship. It will lead us to a mixed funding system of healthcare with increasing co-payments, more user charges in the next parliament, and a growing healthcare insurance market, which will result in an inequitable service, based on a US managed care model, where the poorest and most vulnerable people in society who need most care, will get the least access.<br />
<br />
The Health and Social Care Bill has no democratic mandate, it lacks any sound evidence base, it is ideologically driven, it is highly unpopular with the majority of healthcare professionals (most notably GPs), and it undermines the founding principles of the NHS, which is the most popular institution in Britain. It is an affront to the citizens of the UK.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-bookmark: OLE_LINK1;">Despite this, the coalition Government has ignored calls from the medical profession to withdraw this destructive bill. The underlying principles of the NHS are therefore under severe threat as the bill gets closer to being enacted by Royal Ascent.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-bookmark: OLE_LINK1;">The complexity of the bill, the misleading spin by the Government, the lack of health policy expertise in the national media, the problems faced by New Labour of being an effective opposing force, and most importantly the nature of the coalition, which gives the Government a majority on both Houses of Parliament, has allowed this flawed and dangerous bill to get so close to being enacted.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-bookmark: OLE_LINK1;">Our greatest and most popular national institution is being stolen away from under our noses.<br />
<br />
As co-chair of the NHS Consultants' Association, which actively supports and promotes Bevan’s idea of a publicly funded, publicly delivered, publicly accountable NHS, and someone who is proud and privileged to work in the NHS, there was no question that I would ignore the motto of the NHSCA, which is Bevan's famous quote about the NHS:</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-bookmark: OLE_LINK1;"><em><strong>"it will last as long as there folk left with the faith to fight for it."</strong></em><br />
Hence, in the memory of Aneurin Bevan, myself and Dr David Wilson, a fellow member of the NHSCA, will be carrying and posting 3 signed "Bevan's postcards" to David Cameron's constituency office in Witney and Number 10 Downing Street; and Andrew Lansley in the Department of Health.<br />
<br />
We will not let the coalition Government steal the NHS from the nation without a fight.<br />
<br />
Thank you for your support.”<br />
<br />
Clive Peedell and David Wilson</span></div>Clive Peedellhttp://www.blogger.com/profile/14800348230625234141noreply@blogger.com1