Wednesday, 30 March 2011

An NHS in peril.

Readers will doubtless have heard many of these arguments on this blog in the past, but as this post was written for OpTank, I have tried to write the most complete summary of the reforms that I have done to date.

From 'Moral Leadership' to privatisation

In 1944, with the country emerging from a devastating war and crippling debts, Aneurin Bevan was tasked with introducing a health care system fit for a new era of Britain's history, which would treat patients based on need rather than wealth. In July 1948 he unveiled the National Health Service at Park Hospital in Manchester. The institution, he said, gave us 'the moral leadership of the world.'

Aneurin Bevan: Architect of the NHS

62 years later and the National Health Service faces the greatest threat to its existence in its history. Andrew Lansley's reforms may not remove the NHS from our lexicon, but it threatens to take its very soul, leading us on an increasingly rapid path towards a time when the NHS will be nothing but a brand name.

This all seems very melodramatic, but looking closely at the reforms shows that they are not merely a reshuffle of management, nor about cutting bureaucracy, but about a fundamental shift in what the NHS stands for and how it works to achieve those ends.

Forcing Competition into the NHS

For reform which is intended to give much more power to doctors in guiding patient care it is notable that nearly the entirety of the medical profession is united in its opposition to much of this bill. The reason being that whilst GP-led commissioning is welcomed, there is a widely held belief that this portion of the bill is merely a fig leaf to mask its more sinister elements, the elements relating to competition.

Monitor, which currently has the role of regulating foundation trusts, will now regulate competition in the NHS, ensuring that any willing provider is able to tender a bid for NHS services. No longer will Monitor focus on patient care, but will instead focus on enforcing competition, fragmenting well established partnerships at a local level when they are deemed 'anti-competitive', and leaving the patients with a poorer service as a result. NHS services will be at substantial risk of closure as the most profitable parts are cherry picked by private providers.

For those reasons, a recently convened Special Representative Meeting of the British Medical Association passed the following motion:

"That this Meeting believes price competition is a hugely retrograde step and:- i) that price competition in healthcare is damaging; ii) that with scarce resources the prime focus will be on cost and not quality;"

Indeed, that very same meeting passed a range of motions providing a devastating critique of the health reforms. People who watched the meeting will know that the Health Secretary was only spared a vote of no confidence because of the plea of the chairman not to hinder negotiations and lobbying. The motion may not have passed, but be under no illusions, few at that meeting had any confidence in Andrew Lansley whatsoever.

Furthermore, even if the detail of the reforms wasn't hugely dangerous, the pace and scale are mystifying. To enforce a £3 billion top-down reorganisation on the NHS at a time when the organisation is being asked to find further savings of £20 billion to protect services for the future is outrageous and wholly unnecessary.

Lies, damn lies, and Cameron's statistics

The government is of course keen to stress that reform is necessary, that the NHS simply doesn't perform well enough as it stands. Facts, however, would seem to dispute those claims.

Firstly, despite the attempts by the secretary of state to hide the research, it is now known that patient satisfaction with the NHS is at an all-time high. Hardly a sign of an organisation in peril.

Secondly, it seems a new favourite claim of David Cameron that we are performing very badly in preventing and treating both heart disease and cancer. He may be better served by first seeking to understand the meanings and trends behind research before diving into the argument with his own ill-judged opinions.

Whilst we may have higher mortality rates from heart attacks than nations such as France (which is the lowest in Europe) we have seen the greatest reduction in those rates during the past 30 years, and on current trends will have lower rates than France as soon as 2012. All this despite seeing a lower increase in health spending.

Again, with the claims on cancer, the independent King's Fund showed that our survival rates were improving. And comparisons to nations such as Bulgaria neglect to mention the fact that the two nations have very different levels of cancer registry coverage, making comparisons naive at best, and deceitful at worst. Perhaps it is for these reasons that the BMA also passed the motion:

"That this Meeting deplores the government’s use of misleading and inaccurate information to denigrate the NHS, and to justify the Health and Social Care Bill reforms, and believes that:- i) the Health Bill is likely to worsen health outcomes as a result of fragmentation and competition;"

In summary

There are positive elements to this bill, but they are few and far between. GP-led commissioning could be implemented without the need for legislation. It is only now being used as the government hopes to pass through damaging reforms in the name of greater power for patients and doctors. And when those reforms are widely rejected by the BMA, the Royal College of GPs, the Royal College of Nursing, the Kings Fund, UNISON, and even ex-GP, now Conservative MP Sarah Wollaston, it is time for a rethink.

In 1951 Aneurin Bevan resigned from the cabinet over the introduction of a 1 shilling prescription charge introduced to boost the Treasury coffers. Lord knows how he would react were he alive to witness the destruction being rained down on the nation's crown jewel by the lunacy of Andrew Lansley.

In his now oft-used quote, Bevan said that the NHS 'will last as long as there are folk left with the faith to fight for it.' With petitions gathering pace, and demonstrations planned, it is time for the public of England to stand up and show that they still have the faith, and that they will fight for their NHS.

Tuesday, 29 March 2011

The smearing of UKUncut

It's taken a little time for all the details of events at Fortnum & Mason to be clear, and in that time it seems UKUncut has been getting a very bad press indeed. For an organisation that enjoyed a range of support from the Guardian to the Daily Mail, this is a very new experience.

People from all shades of the political spectrum have been, including the left who claim they ruined the message of such a well organised and executed march. Several MPs who supported their cause in the past have withdrawn that support, and those that insist on continuing to support them like John McDonnell are labelled radicals.

I'm not going to write another long post about why I think they're such a breath of fresh air in protest, or why their message needs to be heard. Instead, I thought I'd leave a selection of the most important links to help people understand what went on. Hopefully, they will provide the proof that far from changing tack and becoming more radical, UKUncut are just as peaceful as they ever were, and that they were badly let down by both police, and by other more violent protesters.

- Video proof that shows police first promising that UKUncut would be free to go before then breaking said promise and arresting them individually once outside, as well as police officers inside the building appreciating the peaceful nature of the protest. Video found here.

- Personal story from one of the protesters detailing conditions which the protesters were kept in, and the bemusement of the police who 'regretted having to charge the protesters on orders from Scotland Yard.' Story here.

- A few photos from the occupation at Fortnum & Mason's showing the 'damage' and peaceful nature of the protesters. Photo album here. (Hat-tip to @MissEllieMae)

- A slideshow on the frontpage of UKUncut's home page showing the range of people attending their entirely peaceful protests, from very young children to the elderly. Page here.

- Finally, a video from inside Fortnum & Mason's during the occupation. Bagpipes? Yes. Vandalism? No. Video and article here.

Thursday, 24 March 2011

Grey Haired Manky Codger

I'm sure many of my readers may well have already seen this, but I needed to share it. My disgust at Andrew Lansley and his privatisation plans are no secret, so obviously a rap about him and how bad his plans are was always going to be a favourite of mine. No doubt it will be sung many times at the march on the 26th in London.

Monday, 21 March 2011

The Libyan Conundrum

Libya is something of a conundrum for many in the West, and indeed those in the region itself. How best to support democratic revolutions without imposing regime change, which was so disastrous in Iraq? And when that revolution falters, and the regime in power threatens genocide, what measures are acceptable to take without being seen to once again be meddling in the Middle East?

It's important to note that this is less polarising than Iraq, the UN resolution and circumstances on the ground see to that. There are people who care about the rights and cultures of other people on both sides of the argument, we just disagree on whether on not this No-Fly Zone is the right way to protect the Libyan people. I'm of the view that it is.

I think for all the arguments that will inevitably come to light about our hypocrisy in intervening in Libya but not in places like Bahrain, about our interventions invariably being linked to oil, and about the other hypocrisy of now attacking the very weaponry we once sold to Colonel Gaddafi, those questions are of no importance or interest to the people of Benghazi who were seemingly on the brink of a brutal massacre just as the UN resolution was passed.

We can rightly ask questions about our general policy in the Middle East at another time, or even alongside Libya, but I don't think we can use our past mistakes as the sole reason to stay out of Libya. We should treat each case individually as it comes along.

It was clear to the world that many Libyans would never be safe under Col. Gaddafi's rule, we had the support of others in the region, and crucially waited for multilateral involvement before intervening. Those facts make it compare favourably to other western interventions of the past.

I understand the arguments against our intervention, but simply could not see an alternative which did not involve the slaughter of innocent civilians. Yes, other places are in a similar situation, but our inability to help everyone shouldn't stop us helping anyone. And I am not accusing those who oppose intervention of being heartless towards the Libyan people, far from it, it is just that I just could not personally have accepted us standing on the sidelines on this occasion.

What we must now focus on is not whether or not the NFZ was the right way to go, but where we go from here. There are still massive questions that need answering. What constitutes mission accomplished? What happens if we're left with stalemate, Gaddafi in the West and the rebels in the East, how long can we maintain the NFZ? Will this only finish when Gaddafi is killed, and if not then how can you ensure peace with him still in power?

Big and important questions, the answers to which will determine whether Libya is the turning point for western interventionism, or just another grubby black mark on our relations with  the Middle East.

For a good post that disagrees with me and is against our intervention, visit this blog.

Thursday, 17 March 2011

Tuition Fees plan in meltdown.

We're now beginning to see the fruits of the ill thought out and ideological increase of tuition fees, as universities line up one by one to ignore the governments plea and charge the full £9000. 

Charging the full amount was supposed to be the exception, but it's fast becoming the rule as we discover that the Office for Fair Access which was set up to monitor the new levels is completely impotent to stop universities charging what they wish so long as they make a courtesy gesture towards the very worst off students.

All of this comes on top of the news that some graduates will end up paying back twice the amount that they borrowed for tuition fees, with many never being able to pay them back fully.

No university wants to be seen as the 'cheap and tacky' option, and so charging £9000 s a way for them to appear to be good quality. And with their funding being slashed, who can blame them?

Here's the article from the Independent.

Doctors harden their stance.

I couldn't make a return to blogging without first talking about the BMA meeting that took place two days ago, where doctors came out against just about every single major part of the Tory Health Bill. I call it the 'Tory' bill because it's now also clear that their partners in coalition object to it as well as everyone in health care.

Here's a selection of the motions that were approved by the meeting:

- That this Meeting believes that the current plans for reform are too extreme and too rushed and will negatively impact on patient care. We call upon the Health Secretary to:- i) call a halt to the proposed top down reorganisation of the NHS; ii) withdraw the Health and Social Care Bill; iii) consider and act on the criticisms and advice from the medical profession that were collected during the White Paper consultation; iv) adopt an approach of evolution not revolution regarding any changes to the NHS in England.

- That this Meeting believes that the proposals in the Health and Social Care Bill were not part of the election manifesto of either of the coalition parties, and calls on the government to accept that:- i) there is no electoral mandate for the introduction of such changes.

- That this Meeting deplores the government’s use of misleading and inaccurate information to denigrate the NHS, and to justify the Health and Social Care Bill reforms, and believes that:- i) the Health Bill is likely to worsen health outcomes as a result of fragmentation and competition.

As well as these more general points, each individual part of the bill was itself dissected and rejected. And whilst the BMA called for the withdrawal to the bill, it stopped short of opposing it in its entireity. However, people watching the meeting online will have noticed this was more of a result of the Chairman's plea to not tie the negotiators hands rather than any particularly good parts of the bill, the proposer of the motion to oppose the entire motion got the loudest standing ovation of the entire day.

Equally, Andrew Lansley was only spared a No Confidence vote because Hamish Meldrum appealed to the meeting and because the Special Representatives would have no more confidence in whomever replaced Andrew Lansley.

Whilst at the time I was disappointed the tone wasn't more strident from the BMA, I now see it has its benefits. The claim from David Cameron that the BMA is 'just another trade union' is frankly laughable in light of this meeting. The debates held were a million miles from the Punch and Judy politics of the House of Commons and despite being baited by politicians who insisted they would ignore the insights of doctors the BMA insisted on continuing to engage.

Frankly, Parliament could learn a lot from the democracy of the BMA. And they should certainly listen when the people who know the NHS the best say that this will destroy it.

P.s. I noticed that a favourite way to claim doctors were onside was to point to the number of GPs who were already involved in pathfinder schemes. I should make it clear to Lansley, these GPs didn't take part because they like the scheme (at least the majority didn't), most did so because PCT's are in meltdown because of these changes and someone needed to step in to fill the gap or patients would suffer. Unlike Lansley, GPs were simply putting patients before ideology.

Hello again!

People may have noticed that I took an impromptu break from blogging. call it burn-out or just plain boredom, but I didn't feel like writing for quite some time. Now however, I want to get back into it, so expect a flurry of posts coming up soon to make up for my absence.