Today, we bring you a guest entry from Karen Jennings, UNISON Assistant General Secretary. She highlights the fact that concessions are beginning to be made with the Health Bill, and identifies the key challenges we have yet to overcome if we are to retain a health service run in the interests of patients and the general public.
The question I keep asking myself is how much longer can the Government go
on ignoring the mountain of evidence that the Health and Social Care Bill
will damage the NHS irrevocably¹? What makes them turn their backs to the
widespread opposition from patients, staff, health experts, charities,
managers, doctors and even some of their own MPs, when the Bill is
undemocratic, unaffordable and unnecessary?
Then I hear Andrew Lansley, talking up the Bill, extolling the virtues of
competition and the private sector and the answer becomes clear this is
very much his vanity project. Despite the fact that the proposals were not
in the Tory manifesto, it is obvious that he had been working on them long
before the election last year. Not only that, but the speed with which the
Government rushed out the White Paper, suggests much of the detail was also
in place even before the Coalition came to power.
But Tory manifesto promises don¹t amount to much. We heard a lot of talk
about the NHS being ³safe in Tory hands², about ring-fencing budgets. The
reality is very different. £20bn demanded from NHS Trusts in so called
efficiency savings. This toxic prescription is already leading to rationing
of treatments, operations being delayed, staff being laid off, damaging
services and ultimately patient care. This is because this is the wrong
Bill at the wrong time.
A recent survey by the NHS Confederation found that NHS managers are warning
that they are so worried about keeping control of their finances that the
Government¹s reforms are taking a back seat.
However, we have seen some small chinks in Lansley¹s armour. He has had to
bow to heavy pressure from unions and critics and recently executed a couple
of policy u-turns.
He now claims that it was simply ³wrong² that he wanted ³to introduce price
competition into the NHS² a real change of heart, but will the words
become reality. If price competition is indeed no longer Government policy,
they need to ensure that loopholes aren¹t exploited that would bring in the
tendering of clinical services.
The Government has also withdrawn damaging plans to allow private companies
to be paid more than NHS hospitals for delivering the same services.
The plans would have allowed private companies to get a premium for
delivering services to patients, as a way of expanding their share of the
But the fundamental point remains the Health and Social Care Bill is the
biggest upheaval in the NHS¹s 62-year history and will change the health
Perhaps one of the saddest aspects of the Bill is that it will change the
relationship between GP and patient forever. By handing over four fifths of
the NHS budget, £80bn of taxpayers¹ money, directly to GPs, the whole
patient: doctor dynamic changes forever. These changes bring with them the
whiff of suspicion. Is my GP not willing to send me for that expensive
scan, prescribe a particular drug or send me for a hip operation, because I
don¹t need it, or are they trying to save money? Is the private hospital I
have been sent to the best care option, or just the cheapest? Is my GP
pushing this therapist because they have a successful track record, or
because they have signed a bargain basement deal? Am I just a victim of a
postcode lottery, and if I went to another GP would I get a better service?
Having one eye on the patient and the other on the balance sheet can do
nothing to boost patient trust. Private companies are already beginning to
make headway into the NHS as a result of the government pushing on with
changes even before the legislation has gone through: ie McKinsey is already
involved in 25 pathfinder consortia (out of 177).
At the same time the Bill contains repeated references to the Competition
Commission and the Office for Fair Trading, completely at odds with a public
health service that should be treated as distinct from privatised utilities.
Not long ago, David Bennett, newly appointed chair of Monitor, said in a
Times interview, that the new system will allow the overhaul of the NHS in
very much the same way as the utilities and railways in the 80s – as if this
was a good thing!
And perhaps the most dangerous consequence of inviting a plethora of private
companies to take over major parts of the NHS currently a very large, very
public organisation, has yet to be fully realised by the public at large.
There is special provision made for EU regulations which open the NHS up
to EU competition law. With the intensification of the market, the extent
to which NHS activity could be challenged under EU competition rules becomes
a serious danger. If services have to be put out to tender, it will be
impossible to bring them back under an NHS umbrella this is a one way
street for the NHS and the direction is privatisation.
The real question here is what are the consequences of a free market on the
quality of patient care? The Bill removes the cap on the number of private
patients that NHS hospitals are able to treat. With competition the new game
in town, this is one way that hospitals will be able to boost their income
taking in more private patients.
At the same time EU Cross border healthcare means that private patients with
money to spend, can look to hospitals in the UK for treatment. When private
patients can buy themselves to the top of the queue, NHS patients will
The bottom line is that this Bill is undemocratic, unaffordable and
unnecessary. It should be pronounced DOA.