With the failure of the last challenge to Andrew Lansley’s wretched NHS reform bill in the House of Commons, where Labour’s emergency debatewas defeated by 328 votes to 246, I have to ask: how is it possible, in a so-called democracy, for a government without a mandate to ignore the complaints of healthcare professionals, at every level, and push ahead with a bill that will do more damage to the NHS than anything in the health service’s 64-year history?
Criticism of Andfew Lansley’s bill, throughout the NHS, has been intense from the moment it was first unveiled last January, as I reported last February, in an article entitled, Battle for Britain: Resisting the Privatization of the NHS and the Loss of 100,000 Jobs, and in March the BMA (the British Medical Association), which represents 140,000 doctors and medical students, voted to “call a halt to the proposed top down reorganisation of the NHS” and to “withdraw the Health and Social Care Bill.”
After a temporary halt to the bill, and a fake “listening exercise,” the government resumed its assault on the NHS, as I explained in two articles in September, Save the NHS: Make No Mistake, the Government Plans to Privatise Our Precious Health Service and Save the NHS: As Lib Dems Vote to Support Tory Privatisation Plans, The Last Hope is the House of Lords, in which I quoted Colin Leys, an author and an honorary professor at Goldsmiths College, who, in an article entitled, “The end of the NHS as we know it,” complained that “many, if not most, of the political elite no longer care whether they are carrying out the wishes of the electorate, and barely pretend that we are any longer a democracy,” and spelled out what the bill means:
The bill will end the NHS as a comprehensive service equally available to all. People with limited means will have a narrowing range of free services of declining quality, and will once again face long waits for elective care. Everyone else will go back to trying to find money for private insurance and private care. More and more NHS hospital beds will be occupied by private patients. Doctors will be divided into a few who will become rich, and many who will end up working on reduced terms and with little professional freedom for large corporations (the staff of the hospitals that are being considered for handing over to private firms will have noted that the firms in question want “a free hand with staff”).
The costs of market-based healthcare — from making and monitoring multiple and complex contracts, to advertising, billing, auditing, legal disputes, multi-million pound executive salaries, dividends and fraud — will soon consume 20% or more of the health budget, as they do in the US. Neither the Care Quality Commission nor NHS Protect (the former NHS Counter-Fraud Unit) are remotely resourced enough, or empowered enough, to prevent the decline of care quality and the scale of financial fraud that the bill will introduce.
Colin Leys’ article coincided with the House of Lords passing the bill at its first reading. 400 senior doctors and public health experts then called on the Lords to throw out the bill at its second reading, but these entreaties failed as well.
As other challenges emerged — a petition launched by 38 Degrees, which has now been signed by nearly 600,000 people, amendments in the Lords designed to make the bill better (or less bad), and a successful Freedom of Information challenge in which the government was ordered to release the strategic risk register regarding the dangers associated with its proposed reforms — health professionals renewed their complaints.
Last month, nearly 100,000 GPs and physiotherapists called for the bill to be scrapped, adding their opposition to that already voiced by the Royal College of Nursing and the Royal College of Midwives, and on March 7 NHS workers held a rally in central London at which they stoutly defended the NHS’s founding principles, at the same time that the Royal College of Surgeons agreed that the bill would “damage the NHS and widen healthcare inequalities, with detrimental effects on education, training and patient care in England.” There were also other challenges — apparently from inside the Tory cabinet, and from the public, 52 percent of whom said, three weeks ago, that the bill should be dropped. Over 170,000 people also signed an e-petitiion by Dr. Khalash Chand calling for the bill to be dropped.
The most recent professional opposition to the bill came last week, when the Royal College of Physicians (RCP) polled its 25,417 fellows and members, and 49 percent of those who responded (8,878 members in total). said they wanted the RCP to “seek withdrawal of the bill.” The survey, as the Guardian explained, “followed the college’s recent extraordinary general meeting to decide its stance on the bill, after some members said it was not being robust enough in its opposition.”
In a specific question to members asking them “what their main concerns were related to the bill and the wider health agenda,” the results “showed that large numbers of hospital doctors fear it will have a negative impact.” As the Guardian described it, “Concern about possible privatisation of the NHS, and the planned extension of competition between healthcare providers and choice for patients, loomed large, though many are also worried about the effect of handing control of £60bn of patient treatment budgets from April 2013 to local groups of GPs called clinical commissioning groups (CCGs),” which “will exercise considerable power, including over the commissioning of services for patients from hospitals.”
The poll “also found widespread unease about issues already facing the NHS at the frontline, including the quality of patient care, budget cuts, staff shortages and patients not getting continuous care.”
However, none of this has been enough to derail the bill. Just 11 days ago, the government lost its appeal against the release of the risk register, prompting Lord Owen to table an amendment yesterday calling for the House of Lords to delay approving the bill on its third reading until the risk register was published, and could be analysed, but even that failed, losing by 115 votes, as did another amendment by Baroness Thornton, Labour’s health spokeswoman in the Lords.
Her amendment, which was defeated by 95 votes, called for the bill to be stopped because it “does not command the support of patients who depend on the National Health Service, the professionals who are expected to make it work, or the public; will not deliver the promised objectives of genuinely empowering clinicians in the commissioning process and putting patients at the heart of the system; will increase bureaucracy and fragment commissioning; will allow Foundation Trusts to raise up to half their income from private patients; and, despite amendment, still creates an economic regulator and regime which will lead to the fragmentation and marketisation of the National Health Service and threaten its ethos and purpose.”
In an interview prior to the vote, Baroness Thornton not only explained how the health service would end up as “a terrible bureaucratic, expensive and fragmented NHS,” but also highlighted how the government was still lying about it. As an example, she pointed out that the government “promised patients would get local champions to challenge the NHS over decisions,” even though, “it emerged last week that these bodies would not be ‘statutory,’ leading to allegations that the government would instead be ‘privatising patient voices,’” as the Guardian described it.
As Baroness Thornton said, “Look at the idea that patients would get local champions so that there would be, in the government’s own words, ‘no decision about me without me’. It was just a lie. We are left with something totally inadequate.”
The government’s last hurdle came this afternoon, with an emergency debate in the House of Commons, secured by the shadow health secretary Andy Burnham, to ask, as Lord Owen did in the Lords, for a delay because the risk register has not been published. That too was defeated, however, with Andrew Lansley brushing off the request for a delay, breezily stating that he couldn’t say what the government’s response would be to the full ruling from the information tribunal about the risk register because he hadn’t seen it, leaving Andy Burnham to complain that the government “should respect the law,” pointing out that ministers “do not have the permission of the people of the country to put the NHS through its biggest re-organisation in history,” and that they are making a “catastrophic mistake.”
After the vote, Andy Burnham was left to lament:
The only hope I can give to people worried about the future of the NHS today is that this might be the end of the bill, but it is just the beginning of our campaign. The NHS will find a way of working around these changes. It won’t deteriorate overnight. And we will be working to mitigate the worst effects of this bill …
While on a day like today it’s hard for me to give any encouragement people worried about what the Government is doing, I can at least say this: that we will repeal this bill at the first opportunity and restore the N in NHS. We have given this fight all we had. All I can say is our fight will go on to protect and restore our party’s finest achievement.
Andrew Lansley’s wretched bill will now become law, and today is, therefore, a very dark day in British political history. The only hope is that it kills the Tories and the Lib Dems at the ballot box, and that Labour, learning from its own mistakes in paving the way for Lansley’s bill through its own obsession with privatisation and corporate interests, continues to campaign for the bill to be repealed.
In conclusion, for an up-to-date analysis of the disastrous effects of the bill, I’m cross-posting below an article by Colin Leys, published in the Guardian three weeks ago.
I don’t know what else to do now, except to urge people to continue to register their dissent, and to work with unions, and other people within the NHS, who are determined to continue to oppose the worst effects of the changes.
NHS bill: goodbye comprehensive healthcare, hello private insurance
By Colin Leys, The Guardian, February 28, 2012
Andrew Lansley and his colleagues assure us that under their plans to privatise the NHS, “services will still be free at the point of use”. But they fail to add a key proviso: provided the services are still available. In reality, a growing list of services won’t be available, and so won’t be free.
Of course, some services that the NHS originally provided, such as long-term care for frail older people, have long been officially withdrawn; and others, like prescriptions and dentistry, are still provided but subject to charges. Under the health and social care bill there will be further contraction of what is provided free on the NHS. Local clinical commissioning groups, not the secretary of state, will decide what services it is “reasonable” to provide out of the budgets they are given, and the package will gradually contract.
This process has already begun under the pressure of the so-called productivity savings recommended by McKinsey. NHS services are being withdrawn in an unannounced, piecemeal and unaccountable way.
In 2006, Croydon primary care trust drew up a list of 34 procedures that would not be paid for in cases where they were judged ineffective or “cosmetic”. But the list also included cataract surgery and hip and knee replacements, on the grounds that their benefits were minimal in “mild” cases. Obviously, what is considered a mild case is liable to be modified by financial pressures. By 2010, the Croydon list was being used widely by other PCTs as a means to save money. In some areas, one commentator noted, “only ‘urgent’ treatment — cancer, fractures and A&E — are funded, and all other procedures are either delayed or the patient is denied funding”.
So a new postcode lottery for treatments has developed, largely unreported. NHS North Central London has a relatively short list of 36 treatments it won’t pay for unless there are special circumstances. South West Essex has a list of 213. In effect, people who need these treatments have to pay for them privately and if they can’t pay for them, they have to do without.
On top of this, GPs are being prevented from referring patients to specialists. In some areas indebted primary care trusts have simply limited each GP to a maximum of four referrals a week, regardless of how many patients need specialist attention. In other areas GP referrals are being intercepted by referral facilitation services (a name that might have been invented by Orwell himself), also called “referral gateways”, run by private firms. One of the first was in west London, where the American health insurer UnitedHealth has a contract to override GPs’ judgments and tell patients to have physiotherapy or use more painkillers instead of seeing a specialist.
A patient with good communication skills and determination may manage to overcome this obstacle. One west-London patient whose NHS surgeon had previously told her she needed a new knee, but who was denied it by UnitedHealth, had to pay over £1,000 and spend a year getting a scan and other surgeons’ opinions to finally prove she needed it, and get back onto the NHS waiting list. But for many this is not possible. For them, free specialist services turn out not to be available.
Under the bill the range of what is available for free seems certain to contract further. Commissioning groups will have fixed budgets. The for-profit “support organisations” that are being lined up to do most of the commissioning for them will have a strong incentive to limit costs, and therefore the treatments to be paid for. CCGs also look likely to be free to decide that some treatments recommended by hospital specialists are “unreasonably” expensive, and refuse to pay for them, as health maintenance organisations do in the US.
A core of free NHS services will remain, but they will be of declining quality, because for-profit providers will cherry-pick the most profitable services. NHS hospitals will be left with the more costly work, so staffing levels and standards of care will be forced down and waiting times will get longer. To be sure of getting good healthcare people will increasingly take out private insurance, if they can afford it. At first most people will take out the cheaper insurance plans now on offer that cover just what is no longer free from the NHS, but gradually insurance for most forms of care will become normal. The poor will be left with a limited package of free services of lower quality.
What is available on the NHS should be determined nationally, in a transparent and democratic way, not by unelected local bodies. The bill will allow the secretary of state to deny responsibility when good, comprehensive, free care has become a thing of the past.