Lots of focus has been on the Tory party, and rightly so, about their part in the NHS reforms. But lest we forget that in the LibDem manifesto prior to the general election it was promised that there would be “an end to the rigging of the market in favour of the private sector”. Although at the second reading of the health bill there were no rebels, there was much debate from some members of the Liberal Democrats suggesting their unease at the proposed reforms.
These could be key people to target to help defeat the health bill.
John Leech has previously campaigned for the safety of hospitals and public services within his constituency. At the second reading he pressed for assurance that private provision would not be at the expense of public provision.
“We cannot allow certain providers to be handed work regardless of what patients want and regardless of the quality of the services provided. Where private provision is extended, will it be at the expense of NHS provision? Intense competition for providing services that existing hospitals provide, may take away resources and make it more difficult for NHS providers to maintain services or invest in new technology and equipment. What will happen to existing PCT-owned provision?”
“Appropriate steps should be taken by the Government in the Bill to ensure access to high-quality domiciliary care for all.”
Already openly outspoken about the NHS reforms, Andrew George did not vote in the second reading of the Health Bill, however with support he may feel able to vote against.
Below are some of his comments during the debate:
“Many people are concerned about its timing, when the NHS has to make the biggest savings it has been asked to make in its 62-year history. At the same time I see the biggest shake-up of the NHS in its 62-year history. The Bill is well intentioned, but for it to proceed and not damage the NHS it needs further major surgery in Committee before it returns to the Chamber for Report and Third Reading.”
“Many GPs in my constituency clearly tell me that they are going ahead with the measures before us more out of resignation than enthusiasm for solely GP-led clinical involvement in commissioning. Will the role of GPs in cutting costs be helpful is it likely to put quality at risk?”
“Monitor will set a maximum tariff and then promote competition, which could easily put quality at risk for the sake of price.”
Yesterday Andrew Lansley U-turned on this policy and has said that he only wants competition in terms of care, and not on price.
“Will integration of services be protected? Will the accountability of Monitor ensured? What will be the power of the NHS commissioning board?”
“If “no decision about me, without me” is to apply to service design and patient involvement, is he prepared to intervene to ensure that the public are involved in important decisions such as closure of local hospitals?”
The House of Lords also debated the reformation of the NHS, prior to the second reading in January. Many members are involved in the NHS either as clinicians or supporters and they also have a final say in whether legislation passes through parliament or not, so their involvement in the debate is crucial.
Former Alliance party leader Lord Alderdice has a political interest in mental health, an area that could suffer as a result of the reforms. He made the following comment during the debate.
“We must ensure that all clinicians-not just doctors or GPs-are involved in the commissioning process and that local people, including elected representatives, patients and those who run other third-sector services are involved in the commissioning process, and can hold those principally involved to account. If that can help us to move to greater integration of health and social care, which is already provided by local authorities and is key in so many of our services for the elderly, as well as maternity and psychiatric services, we can put aside our fear that we are moving to some kind of American system or a completely commercial service.”
As a joint founder of the Social Democrat Party (later to become the Liberal Democrats) Lord Rodgers of Quarry Bank has some issues with the coalition’s plans for health reform. Below are a few of his concerns:
“The NHS commissioning board threatens to become the quango of all quangos. In the White Paper, it is described as, “a lean and expert organisation”, despite its huge responsibilities.”
“What will be the regional role of the NHS when the primary care trusts and the strategic health authorities have gone?”
“What will be the role of A&E departments within the new structure?”
“Local people are to decide the services and facilities that they want. Who will choose the priorities? Who will decide? Who will now come together to make use of the highly contentious and political question of the future of other hospital departments nationwide when the PCTs have gone?”
Already suggesting that the Government may struggle to get the reforms through the Lords and openly speaking out against the reforms last month, Baroness Williams had some serious concerns during the Lords debate. She also suggested, “There should be more opportunities for this House-which has a very substantial level of medical knowledge-to debate and discuss reorganisation of the NHS. The greater the discussion and debate, the more likely it is that we will get an outcome on which everyone can agree”.
Some more of her comments included statistics from the Commonwealth Fund report:
“The Commonwealth Fund report, shows that our NHS, along with the one in New Zealand, is almost certainly the most cost-effective system we know.”
Facts from public surveys on the satisfaction Britain has with the NHS:
“The NHS is rated as being at the top of all the large public services. It is ahead of education, and almost all other public services. That means that we have to consider very carefully what we do to reorganise it.”
Some suggestions on commissioning:
“Clinicians on their own will not be an adequate response to the need to change the health service for the better. Commissioning bodies should include not only clinicians but also representatives of the public, some from local areas.”
The coalition manifesto:
“The coalition agreement specifically promised no more top-down reorganisation and, at least as important, there is reference after reference to PCTs, which would mean that anyone who read it carefully would think that PCTs were likely to survive and not suddenly to disappear.”
And issues on accountability:
“Clinicians will need to look at the significance of accountability in a public service that is massively financed by the taxpayer. The provisions for accountability are very weak and not clearly spelt out.”
Crossbench members of the House of Lords have no particular party affiliation, making them crucial to opposition parties.
Lord Listowel has a political interest in young, under privileged persons and so his most crucial comment is important in this respect that it is addressed:
“Will child and adolescent mental health services, be impacted by reform? How may the reforms impact on the transition from CAMHS to adult mental health services, which are currently so poor in many areas?”
MIND, has expressed concerns over the impact that the reforms will have on mental health services, due to disorganisation of care as a result of services being provided by different providers.
With a key interest in public services, Lord Mawson expresses concern over how the reforms will effect modernisation of healthcare in the UK.
“How in practice is government going to use the restructuring of the health service to create a new narrative relevant to modern health? Secondly, what is government going to do to ensure that doctors engage with innovators and entrepreneurs?”
As a previous president of the Royal College of Obstetricians, Lord Patel has an in-depth knowledge of services required for appropriate care within the NHS.
He mentions the framework that will be used for assessing performance:
“Outcomes framework maintains the three domains of quality: effectiveness, patient experience and safety-and has developed five domains. Why are we not going to use an internationally recognised framework for assessing healthcare performance, such as the one developed by the OECD, especially as this not only has parallels with the proposed outcomes framework but includes health improvement and risk factors, as well as the three themes of effectiveness, safety and patient experience, with equity as an overarching dimension? The framework also needs to measure integrated care, care pathways and the quality of care, including social care. How will improvement be assessed? What will constitute acceptable and unacceptable performance and how will it be measured?”
He also questions the need for competition:
“On the question of competition, what evidence exists that increasing marketisation will benefit patients? Is there an example of a country that has had a defined and conscious change to a market-based approach that has led to improved patient outcomes?”
As a practising surgeon Lord Kakkar is at the front-line of NHS services daily. He is also the director of the Thrombosis Research Institute in London and this is the area in which he comments:
“It is well recognised that research and academic endeavour is hugely important to improving healthcare. Indeed, patients treated in systems where there is active research activity often tend to have better clinical outcomes. The issue with the proposed reorganisation is whether the focus on academic health will be sustained. Will there be some opportunity to ensure that the importance of academic medical research is well established and plays an important role in determining some priorities that the board may set.”
As many people, myself included, Baroness Masham on reading the White Paper decided to Google the body “HealthWatch”. Here is her discovery, and one in which she is not alone:
“In the health White Paper it is suggested that there should be an organisation locally called HealthWatch, and a national body called HealthWatch England. I went to Google to find out what it said about HealthWatch. What came up was:
“HealthWatch is an independent registered charity … since 1991, who try to promote evidence based medicine. We are not Andrew Lansley’s HealthWatch”.
Several other HealthWatches came up. Could there not be confusion? With different HealthWatches, it is possible.”
If reading this has inspired you to Do Something, then do it. They Work for You, so let them know that you care just as much as they do about the future of our NHS.