Unhealthy Document Lords Final

8/4/2019 Unhealthy Document Lords Final

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Unhealthy&Unwise:TheHealth&SocialCareBill

Articles & Evidence to Support Referring the Bill

To a Select Committee of House of Lords

Compiledby:

KeepOurNHSPublicNHSConsultantsAssociation

Supported by:

NHS Support Federation Health EmergencyNational Pensioners Convention

September 2011


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Unhealthy&Unwise:TheHealth&SocialCareBill

Articles & evidence to support referring the bill to a Lords Select Committee

CONTENTS

1. ThisNHSU turnwasafake

The Guardian, 6th July 2011

2. OrganogramsshowNHSbecomingevenmorecomplex

Financial Times, 4th August 2011

3. ThepoliticsofNHSreform:specialreportYouGovCambridge, 7th June 2011

Only one in three support the government health bill

NHS Support Federation, 26-28th August 2011

4. AndrewLansleyiswrongGPsdonotsupportthisNHSbillThe Guardian, 27th July 2011

5. SirRogerBoyle:ItishorrificthattheNHSsfutureisthreatenedThe Independent, 26th July 2011

6. Competitioninapubliclyfundedhealthcaresystem

BMJ2007; 335:11269

7. ComparingtheUSA,UKand17westerncountriesefficiencyandeffectivenessinreducingmortality

Journal Royal Society of Medicine Short Reports 2011; 2:60

8. NHSfaresbestonfreeaccesstohealthcareThe Guardian, 19th November 2010

9. DutyoftheSecretaryofStatetoprovideaNationalHealthService38degrees, 30th August 2011

10. For profitcompanieswillstripNHSassetsunderproposedreformsBMJ15th June 2011

11. DoctorslinkstoprivatecompaniesrevealedThe Telegraph, 15th June 2011

12. ThedaytheysignedthedeathwarrantfortheNHSThe Telegraph, 25th July 2011

13. TheendoftheNHSasweknowitThe Guardian, 8th September 2011


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This NHS U-turn was a fake

Andrew Lansley's privatisation remains on track, hidden by apublic relations smokescreen

Jacqueline Davis Wednesday 6 July 2011 20.15 BST

David Cameron, Nick Clegg and Andrew Lansley on a visit to Frimley ParkHospital in Surrey. Photograph: Reuters

After the so-called "listening exercise" many commentators are talking about ahumiliating U-turn by the government over the NHS "reforms" and claimingthere have been significant changes to Andrew Lansley's health and social care

bill. But they are the victims of a massive PR coup by the government, whichmust be delighted with its strategy.

A well-orchestrated political storm greeted the report of the Future Forum,with Liberal Democrats claiming they had ticked nearly all their boxes andConservative backbenchers complaining that the "reforms" had been betrayed

by their coalition partners. Even Alan Milburn was dusted off to say that the"reforms" were now a "car crash" as a result of being watered down too much.But, if you had listened carefully while all this was going on, you would haveheard Lansley reassuring his backbenchers that the core principles of the billremained in place and that no red lines had been crossed, and he was quite

right. Very little of significance had changed and the bill is still on course toachieve its underlying intention, accelerating the privatisation of the healthservice, turning the NHS into a kitemark attached to a ragbag of competingand largely private providers.


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All the mechanisms to do this are still in place. Private companies can still beinvolved in commissioning NHS services and these services will still bedelivered by any "qualified" provider. Thus the commercial sector can stillhold the budget and provide the care. Competition, the aspect of the reformsthat most worries doctors, emerges almost intact.

The rhetoric has been toned down and been rebranded as "choice". However,the code of practice that governs it will be put on a statutory footing, and theresponsibility for ensuring that competition trumps other considerations ispassed to the Orwellian Co-operation and Competition Panel. They move intoMonitor, so claims that Monitor is no longer concerned with competition arepremature, if not misleading.

Foundation trust timetables have been relaxed but there is still no cap on theirprivate income, meaning that many will be tempted to boost their dwindlingresources by increasing private patient numbers, inevitably at the expense ofNHS patients. The secretary of state's "duty to provide" comprehensive health

care is now so obscure that teams of lawyers are working their way throughthe legalese in an attempt to understand it. If this is meant to bestraightforward, why not return to the original wording? Worrying evidence isalso emerging that the bill will specifically make provision for private equitycompanies to buy NHS facilities and asset strip them. Is this really what DavidCameron intended when he claimed that he loved the NHS?

One of the selling points of the original white paper was a 45% reduction inNHS bureaucracy. Now the Royal College of GPs has warned MPs that thenumber of statutory NHS organisations is set to increase from 163 to 521.These include the National Commissioning Board, clusters of strategic health

authorities and primary care trusts, clinical senates, health and wellbeingboards and the GP consortiums themselves, not to mention whatever is left ofthe Department of Health. GPs feel that, far from moving towards acommissioning nirvana where they can improve care for their patients, theyface a commissioning nightmare where they will be responsible for cuts andsubject to enforced competition. They also foresee the end of theirindependent contractor status, as they become subordinate to commercialprimary care organisations. No wonder most GPs feel they aren't ready for thecommissioning role, that it will damage doctor-patient relationships and thatthe NHS will be harmed.

Rather than improving the situation, the Future Forum has done theinconceivable and made matters worse. The few supporters of the original billare now backing away, alarmed by its increasing incoherence. The BMA hastwice voted for the bill to be scrapped, and a British Medical Journal poll this

week showed 93% calling for its withdrawal. Today the heart tsar, Sir RogerBoyle, resigned, saying: "I feel in my bones the current changes are not correctand ministers were not prepared to change them substantially." How muchmore proof is needed that nothing significant has changed? The BMJchristened the bill "Lansley's monster" when it first appeared. The politicianstook it away, slapped on some lipstick and asked us to embrace it. A monster

with lipstick is still a monster. It needs to be terminated with extreme

prejudice.

2011 Guardian News and Media Limited or its affiliated companies. All rightsreserved.


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Organograms show NHS becoming even

more complexJim Pickard, August 4 2011

David Cameron, pre-election, told National Health Service staff there wouldbe no more top-down reorganisations. The recent history of the organisationhad been like a bowl of alphabetty spaghetti, he pointed out.The government is getting rid of primary care trusts. At the same time it iscreating a National Commissioning Board, Clinical Senates, Public HealthEngland, Healthwatch England, Health Education England, Citizens Panels,

Local Education and Training Boards and Health and Wellbeing Boards andshadow Clinical Commissioning Groups.Even now Cameron has insisted that he has been taking out bureaucracy outof the National Health Service. These two graphics would suggest a ratherdifferent situation.Here was the original NHS bureaucracy in graphic form (helpfully drawn upby Labour policy wonks).

Here is the new NHS bureaucracy in graphic form (source: ditto). Whichseems the more complicated and bureaucratic to you?


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One of Ed Milibands victories against David Cameron at PMQs earlier in thesummer was in a debate over the NHS reorganisation and how it wascreating a morass of new bureaucracy. Miliband pointed out that the changes

were increasing the number of quangos from 163 to 521, as we wrote at thetime.


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The Politics of NHS Reform: Special Report

ByMark Gettleson Head of Research, PoliticsHome 7thJune 2011

For more information, please contact [email protected]

Only One in Three support the Government Health Bill

Poll commissioned by NHS Support Federation, 26-28th August

Between 26-28 August a GfK NOP study asked 1,000 people over the age ofsixteen the following question:

The British Medical Association along with other organizations has askedthat the Government Bill to re-organise the NHS be withdrawn even after itsamendments. The Government is arguing that the Bill is necessary. What isyour view?

Respondents were invited to say whether they wanted the Bill passed, droppedor whether they did not know.

The results show that half (49%) wanted the Bill dropped, a third (33%)wanted the bill to be passed and one in five (19%) did not know. Men wereslightly more likely than women to want the bill dropped but the difference

was not significant. The Government did not get majority support for the Billin any region or age group.


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Andrew Lansley is wrong

GPs do not support this NHS billThose GPs who have joined commissioning groups have done so todefend their patients, not support this race to privatisation

Ron SingerWednesday 27 July 2011

The BMA is about to launch a public campaign for the the health and socialcare bill to be withdrawn. Photograph: Bruno Vincent/Getty Images

Many have said the health and social care bill will ruin the NHS. Where dodoctors stand? This doctor opposes the bill. It will reduce the healthsecretary's duty to provide a comprehensive, universal service in England, selloff NHS services to "any willing provider" and replace co-operation withcompetition (euphemism: "choice"). The 20bn of "efficiencies" demandedover five years will mean the NHS shrinks. The better off will buy "health

top-ups", perhaps supported by private insurance schemes to pay for them.

The rest will have an NHS safety-net service only. Polls and conferenceresolutions demonstrate much disquiet among doctors about the race towardsprivatisation. Making GPs responsible for the treatments you can or cannotreceive will move GPs from impartial, generally trusted patient advocate toguardians of their referral budgets. Some "doctorpreneurs" have stakes inprivate health providers. GPs' decisions about you will no longer be impartialor trusted. Doctors and the public are increasingly concerned about this; trustis crucial to therapeutic relationships.Two GP organisations, the National

Association of Primary Care (NAPC) with close government links and the NHS

Alliance a naive implementer of governments' policies are in favour withAndrew Lansley. They contain the GP enthusiasts for getting their hands onthe levers of power allegedly. Allegedly because commissioning groups(CGs) will have little commissioning power after the enormous bureaucracy


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being created the NHS commissioning board and regional outposts,remnants of primary care trusts, health and well-being boards and clinicalsenates has told them what they can and cannot do.

The BMA is about to launch (a little late perhaps) a public campaign for thebill to be withdrawn. It refuses to oppose the bill so it can stay in negotiationwith government rather than leaving the field open to NAPC and the NHS

Alliance. The BMA acknowledges it will end in tears and wants to stay "intouch" to help stitch the NHS back together. Hospital consultants generallydislike the bill. First, it forces their hospitals to become foundation trusts(FTs) free-standing businesses in full competition with multinational,private providers. Services within FTs will be allowed to fail in a full-blown,

winners and losers, NHS market. Second, they fear the alleged power to behanded to GPs and third, because the majority support a publicly funded andprovided NHS in common with most doctors.

The BMA GPs' committee (GPC) sees the dangers of the bill but supports itscommissioning clauses the illusion of power still lingers. It sees itself as

holding back the tide of privatisation and able to make more humane cuts toservices than if the private sector controlled the CGs. In fact, CGs' managerialsupport is likely to come from the private sector. How long before "GP power"is overwhelmed by private-sector honed, bottom-line focused managers?Further, the GPC now accepts that CGs will do little actual commissioning.Instead they will have lots of time to ensure that GPs and their practices stickto ever tighter budgets, cram more patients into already congested surgeriesand refer fewer patients as draconian "criteria" are forced on them by GP"colleagues" in CGs."Ordinary" GPs have reluctantly joined their shadow CGs,allowing Lansley to falsely claim GP popularity for his bill. To show he is

wrong I have launched a petition for GPs to state that their involvement in

commissioning is to defend their patients and the NHS, not to support the billthat they oppose.

The NHS has served us well. It can improve but we know where privatisationleads, especially when linked to a falling budget and a watered-downgovernment "duty to provide". Doctors get an 88% trust rating; politicians14%. Doctors say withdraw the bill. We should be saying it loudly andrepeatedly.

2011 Guardian News and Media Limited or its affiliated companies.All rights reserved.


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Sir Roger Boyle: 'It is horrific that the NHS'sfuture is threatened'

By Jeremy Laurance, Health Editor, Tuesday, 26 July 2011

When Andrew Lansley was appointed to the cabinet by David Cameron inMay 2010 you might have expected the new health secretary to take thetrouble to introduce himself to the leading players in his department. But no- his first meeting with Sir Roger Boyle, who had been toiling away as the

Governments National Director for Heart Disease and Stroke for more thana decade, did not come until a couple of weeks ago, for what Boyle describesas a decapitation.The heart czar had given a speech in which he described Lansleys claim thatthe NHS was over managed as complete baloney. He had critcised the NHSreform strategy of throwing out the old and bringing in the new without evenlooking at things that have worked well, and had warned about the dangers ofdismantling relationships nurtured over years and destroying corporatememory. A day or two later he appeared on the Today programme to re-iterate his criticisms, expressing the widely held view that what the NHS needsnow is stability not more change. Lansley was not pleased. Boyle described

what happened. Miraculously, I found myself in his office. His aides weredebating whether they could sack me before they discovered I was goinganyway. Lansley said he was disappointed I had gone public without tellinghim. Which is fair dos except he could have found out if he had bothered tosee me. It was a short meeting. I had my knuckles rapped.

It is a pity Lansley had not made more effort to find out what Boyle was up tobecause he would have learnt some important lessons about the NHS andwhat it had achieved without the benefit of the market revolution beingushered in under the NHS reforms.

During his 11 years in post - Boyle retired on Friday - the death rate from heart

disease has halved. Waiting times for treatment have been slashed. There aremore surgeons, more patients on drugs (for blood pressure and cholesterol),

better equipped units,and around 60,000 lives saved each year - half fromchanges in lifestyle (such as reduced smoking) and half from improvements intreatment. Not a bad record on which to bow out. The scale of the advance has

been so great that the NHS has had to cut back on training posts for heartsurgeons because there will not be enough work for them to do in the future.

As well as improved health, the NHS is starting to save money. But Lansleywas not keen to trumpet this success. And Boyle thinks he knows why - it doesnot play to the Health Secretarys agenda which is to dismiss everything done

before his time in order to bolster support for the revolution he hasmeticulously planned to open up the NHS market and subject it to morecompetition.


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Competition means more providers, which means more contracts have to beplaced which means transactional costs rise. The allegiances [of the privatecompanies] will be to their shareholders not to the users of the services. Wehave already spent 1billion on redundancy payments. Is that value formoney? If the market was going to work the Americans would have cracked it.My 91 year old American mother in law (who lives in Florida) has to fill in a150 page form each year for her health insurance and then more forms eachtime she makes a claim. I favour evolution, not revolution. We could have gotto the same point without this huge disruption. Everything has effectivelystopped [while the reforms are thrashed out] except the focus on saving cash -it is very unsettling.

Boyle acknowledges that Lansley has an encyclopaedic knowledge of theNHS, honed during his six years as opposition health spokesman. But I dontthink he has got it right. You cannot take a huge organisation like this and get

buy in [to the reforms]. Alan Milburn [Labours former health secretary] didextensive workshops with all the interest groups which gave him moralauthority to implement the NHS Plan in 2000. Even the Thatcher reforms [of1989-91] took three years from white paper to the bill. Just getting a group ofadvisers together isnt enough if you are going to do something as radical asthis.

He is not encouraged by the reformed reforms produced by the NHS FutureForum, following the pause. Lansleys plan felt like the ideas of one manacting without an electoral mandate, and still does so.

They appointed people [to the Future Forum] they knew would give them theanswer they wanted. Even the reformed reforms will deliver about 80 per cent

of what Lansley wanted.

Boyle was one of the first czars to be created and only Mike Richards, thecancer czar, has outlasted him. He avoided rocking the boat - almost to theend - preferring to keep the counsel of close colleagues. But his views areknown to be widely shared within the department and the profession. All theimprovements in cardiovascular care have come from collaboration andleadership. Where is the evidence that competition between commercialproviders makes a blind bit of difference to cost efficiency and quality? Thecompetition I want to see is between clinicians vying with each other over

whose service is the best. If you try and improve care by getting United Health

to provide the service that would be crazy.I absolutely think the NHS is the best public service in the world. It is horrificthat its future is threatened.


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Competition in a publicly fundedhealthcare system

Steffie Woolhandler, associate professor of medicine, David U

Himmelstein, associate professor of medicine

30th November 2007

Are the UK and other countries right to adopt a market based model forimproving their health services?Steffie WoolhandlerandDavidHimmelstein believe that the appropriate response to the US experiencewith such policies is quarantine, not replication

Why would anyone choose to emulate the US healthcare system? Costs percapita are about twice the Organisation for Economic Cooperation and

Development average. Forty seven million people are completely uninsured.Many others with insurance face high out of pocket costs that hinder care and

bankrupt more than a million annually.1 Mortality statistics lag behind thoseof most other wealthy countries, and even for the insured population, clinicaloutcomes and patient satisfaction are mediocre.2 3

This dismal record arises, we contend, from health policies that emphasisemarket incentives. Even as the public share of health spending in the US hasrisen to 60% (box) investor owned firms have eclipsed the public,professional, and charitable bodies that previously managed the financing anddelivery of care. The development and effect of US policies that mix publicfunding and private management has wider relevance because politicians inEurope and beyond are pushing analogous schemes.

Tax financed health spending in US

Official figures for 2005 peg government's share of total health expenditure at45.4%, but this excludes: Tax subsidies for private insurance, which cost thefederal treasury $188.6bn (92bn; 129bn) 2004 and predominantly benefit

wealthy taxpayers

Government purchases of private health insurance for public employees such

as police officers and teachers. Government paid private insurers $120.2bn forsuch coverage in 2005: 24.7% of the total spending by US employers forprivate insurance

Government's true share amounted to 9.7% of gross domestic product in2005, 60.5% of total health spending or $4048 per capita (out of totalexpenditure of $6697)

By contrast, government health spending in Canada and the UK was 6.9% and7.2% of gross domestic profit respectively (or $2337 and $2371 per capita)Government health spending per capita in the US exceeds total (public plus

private) per capita health spending in every country except Norway,Switzerland, and Luxembourg

BMJ2007; 335:11269 http://www.bmj.com/content/335/7630/1126.full


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7 ComparingtheUSA,UKand17westerncountries

efficiencyandeffectivenessinreducingmortality

Royal Society of Medicine Press 2011; 2:60

Please view research via this link online:http://image.guardian.co.uk/sys

files/Guardian/documents/2011/08/07/JRSMpaperPritWall.pdf


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NHS fares best on free access to healthcare

Britain is the only country in the industrialised world where wealth doesnot determine access to healthcare, study finds

Randeep Ramesh The Guardian, Friday 19 November 2010

NHS patients have the best access to care at the lowest cost, according to a US study.

Photograph: Christopher Furlong/Getty Images

Britain's health service makes it the only one of 11 leading industrialisednations where wealth does not determine access to care providing the most

widely accessible treatments at low cost among rich nations, a study hasfound.

The survey, by US health thinktank the Commonwealth Fund, showed thatwhile a third of American adults "went without recommended care, did notsee a doctor when sick, or failed to fill prescriptions because of costs", thisfigure was only 6% in the UK and 5% in Holland. In all the countries surveyedexcept Britain, wealth was a significant factor in access to health, with patientsearning less than the national average more likely to report trouble withmedical bills and problems getting care because of cost. The survey, of 19,700patients in 11 nations, found "substantial differences" among countries onaccess to care when sick, access after hours, and waiting times for specialisedcare. About 70% of British patients reported same- or next-day access todoctors when sick, less than the 93% of Swiss adults reporting rapid access. In

contrast, however, only 57% of adults in Sweden and the US, and less than halfin Canada and Norway, were seen this quickly. The NHS was also extremelycost-effective, with spending on health per person almost the lowest in thesurvey. A person in the UK paid $1,500 less than one in Switzerland and less


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than half the $7,538 paid by every American for healthcare. Only NewZealand, where one in seven said they skipped hospital visits because of cost,spent less per head.

The report was particularly damning about the US, where it found patients"are far more likely than those in 10 other industrialised nations to go withouthealthcare because of costs". Nigel Edwards, acting chief executive of the NHS

Confederation, said the report was a "good result for the UK. The issue inmany other nations is that you buy insurance to cover for the price ofexpensive drugs. Or that you need co-payments on hospital treatments"Edwards said there were issues with NHS care. "I think if you look at why weare not able to treat patients out of hospital well for, say, diabetes, or why wehave high rates of heart disease, or look at cancer survival rates, it would be adifferent story. But the question is whether the government's plans for theNHS help this."

A government spokesperson said: "The UK lags behind many internationalhealthcare systems on survival rates for example, for diseases such as cancer

or stroke and the NHS must reform in order to achieve better outcomes."

Meanwhile a government-commissioned report yesterday suggested thatnational or regional call centres could handle GP appointments under a"radical" change to the system that would save millions. The report, by theFoundation Trust Network, said streamlining "back office" functions in theNHS and "sharing" services would save 600m a year.

However the Department of Health said there were no plans for call centres.

2011 Guardian News and Media Limited or its affiliated companies.All rights reserved.


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9

DutyoftheSecretaryofStatetoprovideaNationalHealthService

38degrees, 30th August 2011

Please view legal advice via this link online:

http://www.38degrees.org.uk/page/content/NHSlegal

advice/


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communities and facilitating patient choice, the content of the bill itself bearslittle relationship to these goals. Most commentary so far has been on the

white paper and not the bill itself; an honourable exception is the analysis byPollock and Price (BMJ2011; 342:d1695, doi:10.1136/bmj.d1695). Becausethere has been little reporting on the substance of the bill, few are aware of thetrue content and direction of the changes proposed.

As the white paper suggests, the bill facilitates involvement of GPs incommissioning consortiums. However, it offers the same opportunity to anycompany which wishes to be a provider of primary medical services (clauses14).

Fifteen clauses (ss125-131, 168-175) collectively create a new insolvencyregime for hospital foundation trusts. You might wonder why this is a priorityin NHS reform. Clues emerge in clause s293, which removes the prohibitionon sale of NHS assets, and s160, which allows foundation trusts to raise loansfor the first time. The government remains mute about the purpose of theseinnovations, but their passage would enable private equity companies to buyNHS facilities and asset strip them. The bill bans the government fromstopping them: clause 4, which adds a s1C to the National Health Service Act2006 guarantees that any other person exercising functions in relation to thehealth service or providing services for its purposes is free to exercise thosefunctions or provide those services in the manner that it considers mostappropriate.

Disturbingly, clause s12 specifically enables privatisation of high securitypsychiatric services. What may we expect once these services are run byproviders which prioritise shareholders pockets above public welfare? It wasthe privatisation of hospital cleaning that brought us deaths from meticillinresistantStaphylococcus aureus.

The government has failed to explain why the NHS, ranked overall second inhealth outcomes and first in cost effectiveness among seven developedcountries (United Kingdom, New Zealand, Canada, Germany, Netherlands,

Australia, and the United States, Commonwealth Fund, 2010,www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2010/Jun/1400_Davis_Mirror_Mirror_on_the_wall_2010.pdf), needs toinvolve profit making providers. Passage of this bill would move us towards aUS-style corporate dominated system. The US produced the worst scores onthese measures in this 2010 comparison and was ranked consistently lowestoverall in previous Commonwealth Fund studies, in 2004, 2006, and 2007.The US achieves worse health outcomes than not only these developedcountries but even impoverished Cuba (WHO, 2009,http://apps.who.int/ghodata/), and at an annual per capita cost ($7410,2009, http://apps.who.int/ghodata/?vid=80201) more than double the UKs($3285) and 10 times Cubas ($707). The changes brought by the passage ofthe bill would be to a more expensive system that will deliver worse quality ofcare: the worst of both worlds.

If David Cameron honestly intends to avoid NHS privatisation, the Health andSocial Care Bill must be amended to exclude for-profit corporate bodies fromcommissioning and service provision. If not, he signals clearly his choice to

benefit potential shareholders at the expense of patients and taxpayers.Concerned readers should contact their MPs urgently to press for this change.


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Doctors' links to private companies revealed

Large numbers of doctors on new health commissioning boardshave links with private healthcare companies, research shows.

15 Jun 2011

It will raise questions over the risk of financial conflicts of interest under theGovernment's health reforms.

Researchers from the Bureau for Investigative Journalism found that 19 out of

the first 52 consortia set up to take on commissioning powers have boardmembers with interests in commercial providers.

One in seven of the doctors - a total of 69 board members - were linked tocompanies, many of them with Assura Medical, a healthcare providercontrolled by Sir Richard Branson's Virgin Group, reported The Independent.

Assura has set up 25 joint enterprises with GP groups to provide community-based services in areas such as dermatology, sexual health and out-of-hourscare, with profits split 50/50 between the company and member practices.Concessions announced by Prime Minister David Cameron yesterday willextend responsibility for commissioning NHS services and treatments beyond

GPs to include nurses and consultants. But GPs will still have a big voice indeciding how NHS cash is spent under the new arrangements.

Health Secretary Andrew Lansley will today explain the new arrangements toan audience including hundreds of GPs when he addresses a commissioningconference in London. Dr Clare Gerada, chair of the Royal College of GPs toldThe Independent: ''If you have any system that you can gain financially frommaking decisions about your patient care, then clearly that is a conflict ofinterest.

''And if you're in a position to commission and you could potentially buy care

from yourself, then I would be very concerned.''

An Assura Medical spokesman told the paper that the company was awaitingDepartment of Health guidance on approaching potential conflicts of interestand would ''ensure our policies are updated to reflect and reinforce thisguidance''.

A Department of Health spokesman said: ''Our plans to modernise the NHSwill improve the current system of accountability in the health service,ensuring that any potential conflicts of interest are dealt with in an open andtransparent way.

''All clinical commissioning groups will have to have a governing body, withpowers to ensure that decisions about patient services and use of taxpayers'money are made in an open and accountable way.


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''These bodies will include two lay members - one of whom must play a leadrole in overall governance, including audit, remuneration and managingconflicts of interest. On Tuesday, David Cameron announced that NHSreforms will be watered down even further than recommended byindependent experts, prompting fears that the new system will increase

bureaucracy rather than reduce it. The Prime Minister denied he had beenforced into a humiliating u-turn and insisted that the core principles of the

changes remained intact.

But he disclosed that new GP-led bodies must include nurses and hospitaldoctors, despite fears of tokenism, while Government plans raise theprospect of new regional quangos to oversee the purchase of care as well asnew advisory groups of medics. The deadlines for the introduction of the newregime, including greater competition from the private sector, have also beenrelaxed while the Bill itself is unlikely to become law until well into next year.David Worskett, director of the NHS Partners Network which representsindependent providers, said the Governments new changes risk a return tocentralised control and added: Overall, the process of reforming the

provider side of the NHS so that it better meets patients' needs has been setback by several years.

Even the NHS Confederation, which represents managers in the state sector,warned: We need to make sure that the new system is not over centralisingand there is real momentum towards the important goal of pushing powerdown to the local level.

And Chris Ham, chief executive of The Kings Fund think-tank, said: Thesheer number of changes being made to the structure of the NHS riskscreating confusion and additional bureaucracy.

Under the original Health and Social Care Bill, two tiers of health servicemanagement were to be abolished and GPs were to form new consortia that

would buy 60billion a year of treatment from either private or state-runhospitals. An economic regulator called Monitor would promote competition

between providers.

But many in the medical profession feared it would lead to the backdoorprivatisation of the NHS while shutting patients and other clinicians out of thedecision-making processes, and the Liberal Democrats forced the PrimeMinister to pause the legislative process for opposition to be heard.

In the Governments response to the NHS Future Forum report on suggestedchanges to the Bill, published on Tuesday, ministers agree that Monitors roleshould be diluted to supporting collaboration rather than a market free-for-all.

There will also be safeguards against private firms cherry-picking easyservices or patients with straightforward conditions, leaving the NHS to do thecostly or complicated operations.

GP commissioning consortia now renamed clinical commissioning groups will no longer have to come into effect by April 2013 while hospitals will not

have to become Foundation Trusts by 2014. Health services will not be openedup to any qualified provider until next year at the earliest. The experts onthe Future Forum concluded that putting nurses and hospital doctors on the

boards of commissioning groups smacked of tokenism but the Government


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has ignored its advice, possibly to secure the support of unions. They will alsoneed at least two lay members, but ministers said more work was needed onthe proposal for patients to have a right to challenge poor services and lackof choice.

The Government also recommended the establishment of clinical networksand clinical senates within a powerful new central body called the NHS

Commissioning Board, which will itself have local arms, threatening toremake the tiers of management being scrapped.

The Bill must now return to committee stage in the Commons, because therewill be so many new amendments to be examined by MPs, making it unlikelythat it will become law until at least February.

However Mr Cameron told a press conference at Guys hospital that the publicwould respect that the Government had admitted mistakes in its original plansrather than ploughed ahead regardless.

He said: Ten weeks ago we pressed pause on our NHS reforms. Now therewere those who said this was a humiliating U-turn, that we were back-trackingand ditching all our plans. And there were those who said the opposite, thatactually we werent going to change anything that this was all a big PR stunt.Today we show that both are wrong. The fundamentals of our plans - morecontrol to patients, more power to doctors and nurses, less bureaucracy in theNHS - they are as strong today as theyve ever been. But the shape of ourplans, the detail of how were going to make all this work, that really haschanged as a direct result of this consultation.

Mr Cameron added: "Politicians hate admitting that we ever got anything

wrong. I think it's a sign of strength actually."

Unions welcomed the climbdown, as did Tory backbenchers who hadpreviously expressed anger that the plans were being diluted at the Lib Dems'request, although many commentators said more detail was still required onhow the new regime will work. John Healey, Labours shadow healthsecretary, described the situation as humiliating for Andrew Lansley, theHealth Secretary, who had tried to brush aside opposition to his flagshipscheme and who has seen Mr Cameron take over the presentation of thereforms. Mr Healey asked him in the Commons: Why no apology to the NHSpatients and staff for the wasted year, chaos, confusion and incompetence?

A succession of MPs asked Mr Lansley how much the process had cost interms of reversing the policy. He replied that that the listening exercise hadcost 36,600. Clive Efford, a Labour MP, said: "This isn't a u-turn, it is a bodyswerve around the Liberals."


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The day they signed the death warrantfor the NHS

Andrew Lansley has announced that, from next April, NHS services worth 1billion will be opened up to competitive bids from the private sector.

Max Pemberton, The Telegraph, 25 Jul 2011

You might think that historians will record last Tuesday as the day theMurdoch empire was brought to book by MPs. Yet I suspect that in years tocome, they will realise the significance of that day, not for the phone hackingscandal but for the health service.

While the nations attention was focused on the most powerful man in themedia attempting to dodge questions and cream pies, this was a good day to

bury bad news. And the Department of Health duly obliged.Andrew Lansley explained that from April next year, eight NHS services worth1billion, including musculoskeletal services for back pain, wheelchairservices for children and adult community psychological therapies, will beopened up to competitive bids from the private sector.

This means that in these areas, the NHS will no longer exist. Sure, the logowill still be there, but the NHS will no longer be national, any more thanBritish Telecom is.

There is no doubt that this signals the first wave of privatising the NHS. YetMPs of all persuasions continue to be deluded.In a letter that has been passed to me, Stephen Williams, Liberal DemocratMP for Bristol West, assures a worried constituent that the NHS Reform Bill

will improve the NHS and therefore definitely not lead to the privatisation ofservices.


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Doubtless Mr Williams means this sincerely. But I wonder if he has actuallyread the Bill. I telephoned and asked him: no, he hadnt. The problem is thatthe MPs who are voting on this assume that the Bills content reflects theGovernments White Paper on the NHS, published last summer. I have read

both and it is clear to me that the White Paper bears little relation to thelegislation that is being pushed through.

The White Paper is a docile, fluffy, patient-focused document, with much talkof choice and empowerment. This is in stark contrast to the Bill, which almostexclusively focuses on opening up the NHS to private providers. The Bill is

written in dense legal terminology, making any detailed analysis time-consuming and difficult.

But anyone who does study it will find little more than a road map fordestroying the NHS, turning it into a cash cow for the corporate sector. Thefocus is on transforming public sector provision into an entirely market-ledsystem, throwing open every service to private providers.

Previous pieces of legislation that existed to ensure the NHS remained inpublic ownership are weakened or removed entirely in the Bill. Even the roleof Secretary of State is altered so that he is no longer responsible for the NHS.There are 15 clauses (ss125-131, 168-175) that will allow private companies to

buy and asset-strip NHS facilities. Clause s12 specifically enables theprivatisation of high-security psychiatric services.

Does that sound as if the NHS, or the interests of patients, are beingprotected?

The concessions made by Lansley after the listening exercise were initially

heralded as an acceptable compromise but, in reality, little has changed. Forexample, any willing provider, a phrase taken from EU procurementdirectives, has been changed to any qualified provider. This type ofamendment does not help protect the NHS. The competitive commissioningprocess it refers to remains unchanged.

After Lansleys announcement last Tuesday, the BMA Council said that theGovernment is misleading the public by repeatedly stating that there will beno privatisation of the NHS and is continuing its campaign for the Health Billto be withdrawn.

Yet MPs are defending the Bill without properly understanding it or even

reading it. Cloak and dagger tactics are used to minimise any public outcrywhen key announcements are made. The health secretary and the PrimeMinister assure us the NHS will not be privatised when the legislation they arepushing through explicitly suggests otherwise.

The Bill enters the report stage and third reading on September 6 and 7. At theend of this, MPs will be voting on the future of your NHS. Is it safe in theirhands?


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The end of the NHS as we know it

The health bill is the final stage of a project that began 25 years agoto turn this vital public service over to the private sector

Colin Leys Thursday 8 September 2011

The A&E area of Birmingham Heartlands Hospital. Photograph: David Sillitoe forthe Guardian

What Wednesday's vote on the health and social care bill shows more clearlythan anything is that many, if not most, of the political elite no longer care

whether they are carrying out the wishes of the electorate, and barely pretendthat we are any longer a democracy.

The prime minister promised before the 2010 election not to introduce any

"top-down reorganisations" of the NHS; to say he, Andrew Lansley and NickClegg lack an electoral mandate for the bill is an understatement. It is also anunderstatement to say that they have not told the truth about the bill'sintentions, and that they have reduced Department of Health statements, suchas its latest so-called MythBuster document, to a level of brazen mendacitythat demeans a once great office of state.

The principle seems to be that if an official lie such as that the bill does notimply privatisation is repeated often enough, most people will feel it must betrue. And by using existing powers to abolish PCTs and set up "pathfinder" so-called GP consortia, and making arrangements with foreign private companies

to take over NHS hospitals, the government has also pre-empted such debateas MPs are inclined to have. The Conservative MP Dr Sarah Wollaston, whooriginally denounced the bill, now says that changes have already gone too farto oppose it any further a remarkable statement of political impotence.


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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 ofdeclining quality, and will once again face long waits for elective care.Everyone else will go back to trying to find money for private insurance andprivate care. More and more NHS hospital beds will be occupied by privatepatients. Doctors will be divided into a few who will become rich, and many

who will end up working on reduced terms and with little professionalfreedom for large corporations (the staff of the hospitals that are beingconsidered for handing over to private firms will have noted that the firms inquestion want "a free hand with staff").

The costs of market-based healthcare from making and monitoring multipleand complex contracts, to advertising, billing, auditing, legal disputes,multimillion pound executive salaries, dividends and fraud will soonconsume 20% or more of the health budget, as they do in the US. Neither theCare Quality Commission nor NHS Protect (the former NHS Counter-FraudUnit) are remotely resourced enough, or empowered enough, to prevent the

decline of care quality and the scale of financial fraud that the bill willintroduce.

What we are witnessing is the completion of a project begun some 25 yearsago to restore healthcare to private enterprise. The key players have not beenMPs but private healthcare companies and consultancies like McKinsey andKPMG. The war has been waged by the lavish corporate funding of pro-marketthinktanks the quiet subversion of some of those, like the King's Fund, thatare still rather quaintly described as "independent" and the deeppenetration of the Department of Health and Labour's senior ranks. Nocountervailing argument has come from pro-public thinktanks, because none

exists with resources equal to the task. And how many MPs have actually readthrough the bill they are in the process of endorsing, or even the explanatorynotes that accompany it?

The one serious obstacle to the bill's promoters has been the impact of socialmedia: 38 Degrees, Facebook, expert bloggers and tweeters. Along with themillion-plus people who work for the NHS, a steadily growing portion of,especially, younger voters, have been exposed to a different narrative and seethrough the spin. At the moment most of them may be more cynical thanpolitically active. But if the bill becomes law and the reality begins to be felt inpeople's daily lives it is this counter-narrative that will make sense. MPs and

now the Lords would be well advised to ponder the implications of this.

2011 Guardian News and Media Limited or its affiliated companies. All rights reserved.

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