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.

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