Health Bill will kill the NHS

  • The NHS will not be National.
  • It will not be comprehensive.
  • Local consortia will be able to decide what services to provide free of charge
  • what services to provide but charge for
  • and what services will not be prvided at all.

That sounds to me like the end of the NHS, certainly the NHS as we know it.

Writing in the British Medical Journal this week Prof. Allyson Pollock reveals some devastating detail hidden away in the Health Bill currently before Parliament.

Since 1948 the Health Secretary has been required to provide comprehensive healthcare throughout the country.

That requirement will be abolished.

Instead Commissioning Consortia will have the power to decide what they feel is appropriate to provide under the NHS. They will also have the power to introduce new charges for NHS treatment.

Dr Charles West local GP, health campaigner and Liberal Democrat spokesman said:

“This really will mean the end of the NHS as a national service. The Commissioning Consortia will have a woolly obligation to arrange for such healthcare as they consider appropriate, and to charge for it if they wish. But they will have a strict obligation to keep within budget. So all the pressures will be to reduce the treatment available to patients.

“What makes it worse is that the bill also allows for surpluses, if there are any, to be distributed to staff or shareholders. So there is a clear incentive to reduce treatment, or to deny patients the treatment they need and pocket the cash.

“To make the whole thing more complicated GP practice boundaries will disappear and different GPs may be in different Consortia. It is therefore quite possible for one patient to be subject to the rules and charges imposed by one Consortium and another patient living not far away to be covered by a different Consortium. It is not clear what obligation, if any, there will be for a Consortium to arrange treatment for a patient who is registered with a different Consortium. I can foresee the possibility for endless arguments about who is going to pay. We could well finish up in the situation that they have in the USA where the ambulance wants to see your membership card before agreeing to take you to hospital, or indeed before deciding which hospital you are allowed to go to.

“Since winning our debate at the National Conference in Sheffield Liberal Democrat health experts have been working hard to negotiate amendments to the Health Bill, but when we discover this sort of bombshell hidden away in the detail I seriously doubt if we can save the NHS by amending the Bill. I suspect that we need to persuade our MPs to throw it out completely.”

“How the secretary of state for health proposes to abolish the NHS in England.” Allyson M Pollock, professor , David Price, senior research fellow. BMJ 2011; 342:d1695
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6 Responses to Health Bill will kill the NHS

  1. Before the election I emailed a series of questions about the NHS to the Tory, Labour and LibDem candidates. Really quite specific stuff. The Tory candidate (sitting MP) came back with platitudes. The Labour candidate was hapless (this is a solid Tory seat, Labour had no chance, so I guess the party did not want to waste any talent).

    The LibDem, however, was interesting. He answered the questions with thoughtful answers and even put forward issues with the current system that I had not thought about. Looking back to that email, I cannot see any overlap with his opinions with the Health Bill. What he was accusing Labour of doing, the Health Bill does, but more so.

    I understand party loyalty, and the politics of coalition, but how can any LibDem party member honestly support the LibDem ministers who have given the Conservatives their de facto majority in Parliament and who will allow this Bill to pass? I am not a LibDem party member, so it is up to people like you to get this Bill stopped (not amended, it is unamendable, so it has to be stopped).

    Me? Well I think that there are a lot of Tory MPs, particularly with shire seats where their local NHS hospital is the *only* hospital, and will find that the Bill will lead to huge local campaigns. They need to be made away of what will happen to their majorities should the Health Bill go through.

  2. Charles West says:

    The following comments were sent by a senior researcher in the Office of the Minister of State for Care Services.

    ” The article says that there might not be comprehensive NHS coverage for all people, and that local authorities will be providers of last resort for patients who cannot access general practices or commissioning consortia.

    – This is entirely inaccurate and based on a fundamental misunderstanding of the Bill.

    – The Bill preserves the Secretary of State’s overarching to promote a “comprehensive health service”, free at the point of use. There is no question of people being denied access to NHS services for geographical – or any other – reasons.

    – The Bill does not turn local authorities into providers of NHS care. What the Bill does is transfer health improvement responsibilities from primary care trusts to local authorities, as set out in the White Paper.

    – Neither GP consortia or local authorities ‘provide’ services – they arrange for the right services to be in place locally, whether public health services commissioned by local authorities or NHS services commissioned by GP consortia.

    The article says that consortia will be able to define entitlement to NHS-funded care, select the most profitable patients, and charge patients for their NHS care.

    – This is entirely untrue. GP consortia have no such powers. The NHS will always be there for those who need it, free at the point of use, funded by general taxation and based on need, not ability to pay.

    What consortia will do is determine the services that best meet the needs of their local communities and arrange for them to be in place.
    – Their close relationships with patients means that they are uniquely placed to do this. There is no question of consortia being able to choose their patients.

    The article says that foundation trusts will be able to charge for hospital accommodation and amend their principal purpose of providing services to the NHS.

    – This is not true – foundation trusts’ principal purpose will always be to provide NHS care, and NHS care will always be available to everyone who needs it, free at the point of use.

    – What the Bill does is allow foundation trusts to amend their constitutions without needing to go through unnecessary bureaucracy first.

    – This does not mean they can amend their principal purpose, which will remain fixed in statute.

    The article says that regulation could be dispensed with as more providers enter the market.

    – This is not the case. We are significantly strengthening regulation to ensure that NHS care is high quality and value for money.

    – We are extending quality regulation by CQC to more providers and the Bill creates a new economic regulator.

    – Providers of NHS care will in future need a licence from Monitor and CQC to show that they provide quality care and value for money. The number of providers delivering health services has no effect on this requirement.”

  3. Charles West says:

    My initial thoughts on the detailed posting above from the Minister’s Office is that although it may be reassuring that those drafting the Bill do not intend to make use of the flexibility offered by the wording of the new bill, it is nevertheless worrying that the wording has been changed.
    Currently the Secretary of State has a duty to “to provide or secure the provision of comprehensive healthcare throughout England.”
    The new Bill only requires the Secretary of State “to promote a comprehensive service”, and to “act with a view to securing comprehensive services.”
    Now I may need to take further legal advice on this, but I think that I could claim to promote something, and I could claim that I have acted with a view to something happening without that thing happening at all.
    It would be difficult to claim that I had provided, or secured the provision of something if nothing happened at all. Charles West

  4. A senior researcher in the Office of the Minister of State for Care Services is a political appointee, not a civil servant, so the comments above must be treated as the same as coming from a politician. Let’s have a look at some of the comments:

    – The Bill preserves the Secretary of State’s overarching to promote a “comprehensive health service”, free at the point of use. There is no question of people being denied access to NHS services for geographical – or any other – reasons.

    We have to look a bit deeper into this. The Bill will remove the mandatory aspect of NICE, that is, they will merely be advisory. This means that consortia will decide on the treatments and since the Bill does not give a right to challenge such a decision (other than to move to a practice in another consortia) this will lead to some treatments being available on in some areas. Such a variation of treatment will be spun as being “localism” but it cannot be described as being “comprehensive health service” since where you live will determine the treatment you get. A comprehensive, universal system would guarantee the same treatment across the country. This Bill specifically rules that out.

    – Neither GP consortia or local authorities ‘provide’ services – they arrange for the right services to be in place locally, whether public health services commissioned by local authorities or NHS services commissioned by GP consortia.

    Well, while this is strictly true, the statutory body of the GP Commissioning Consortium does not provide services itself, the definition of a Consortium is that it is made up of constituent GP practices who will provide services.

    The article says that consortia will be able to define entitlement to NHS-funded care, select the most profitable patients, and charge patients for their NHS care.

    The consortia will decide what treatments they offer. Since NICE will be “advisory” there will be no strict list about what treatment a patient can or cannot have paid for by the NHS. However, Consortia will not be allowed to select patients, other than by making it bloody difficult for a patient to remain with them by not providing the care the patient wants.

    What consortia will do is determine the services that best meet the needs of their local communities and arrange for them to be in place.

    Postcode lottery. Anyway, it is interesting that the researcher says “consortia will determine the services”. And here was me thinking that the point of the Bill was patient choice. As everyone knows (but few will say), Any Willing Provider is nothing to do with patient choice, it is all about commissioner choice (as your researcher confirms). The East of England is currently designing integrated care pathways with Any Willing Provider, and the indications so far is that the commissioners are choosing private providers, effectively privatising a large chunk of NHS care in the area. I wonder if they have been bothered to ask the patients where they would like their treatment? Just a thought.

    – Their close relationships with patients means that they are uniquely placed to do this. There is no question of consortia being able to choose their patients.

    That sounds so quaint. But how does it work with the Oxfordshire Consortium which has 83 practices and 650,000 patients? How close would you regard the commissioners in Oxfordshire are to their patients? A lot further away than the old PCT commissioners, I would say.

    The article says that foundation trusts will be able to charge for hospital accommodation and amend their principal purpose of providing services to the NHS.

    – This is not true – foundation trusts’ principal purpose will always be to provide NHS care, and NHS care will always be available to everyone who needs it, free at the point of use.

    Hmm avoiding the issue there. The Bill abolishes the private income cap. This pegs the proportion of income of an FT to the level at 2003/04. The result of this policy is that FTs will be able to have as many private patients as they wish. Tell me this, if you are paying an insurance premium every month will you want to be in the same queue for treatment as someone who has not paid that money? If so then why bother paying the premium! This will lead to a two tier system. If the principal purpose of an NHS hospital is to provide care for NHS patients and they then change so that a large proportion are private patients, then this means that they have amended their principal purpose.

    – Providers of NHS care will in future need a licence from Monitor and CQC to show that they provide quality care and value for money. The number of providers delivering health services has no effect on this requirement.”

    Huh? At the moment an FT has to be authorised by Monitor (call that a licence if you like, its just semantics) and has to be registered (and hence inspected) by CQC. There is not much of a change from the situation at the moment.

  5. Charles West says:

    Thanks Richard.
    I have been in correspondence with the authors of the paper and they stand by the details of the paper as published (“How the secretary of state for health proposes to abolish the NHS in England.” Allyson M Pollock, professor , David Price, senior research fellow. BMJ 2011; 342:d1695 ).
    Some of the responses may be a bit technical for a general blog, but I would be happy to eMail them to you if you are interested. The general drift is that the authors agree with you and me.
    On the general question of whether the Health and Social Care Bill is significantly amended, withdrawn or defeated I am less pessimistic than you. But the worthy citizens of the UK, (OK, I suppose technically this is England) need to wake up pretty soon before something is set in motion that cannot be stopped. C.W.

  6. Charles, I would be interested (you should be able to get my email through WordPress). I am pessimistic because there has bee so much investment in this bill by Lansley. This is very much his bill and in all that I have read from him (and I am afraid I am somewhat nerdy in that I read the Select Committee and Hansard debates) he has never shown any willing to compromise. The only amendments he’s willing to make are for “clarification”. I think he genuinely believes that this bill represents the only solution for the NHS. There were 100 divisions (representing many more amendments) in the Committee stage of the bill (this stage was the longest for any bill since 2002) and the only amendments that were passed were government amendments. It does suggest that Lansley refuses to accept any other opinions.

    From what I’ve read about what Shirley Williams and David Owen have in store for the bill in the Lords, I think Lansley will be shocked. Williams wants to improve it by removing the very parts that Lansley is depending upon (competition) whereas it sounds like Owen wants to destroy the bill entirely!

    Isn’t it amazing that we are relying on the unelected Lords to amend a flawed bill? This certainly shows that the iron grip of the payroll vote in the Commons desperately needs reforming.

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