Save The NHS. Austin Mitchell MP is against NHS Reforms.

16 May

I recently signed a petition by 38 Degrees to Save The NHS http://www.38degrees.org.uk/page/s/Protect_our_NHS_Petition#petition. Their website also requested that people write to their local MP http://blog.38degrees.org.uk/2011/04/01/email-your-mp-to-save-the-nhs/. So I quickly searched the internet for information and evidence and compiled it, cobbling together this letter for my local MP, Austin Mitchell.

Dear Austin Mitchell MP,

Not long ago the coalition government announced their new reforms would put more power into the hands of doctors. Saying “Dr’s know best how to run the NHS”. That was effectively the government’s motto to sell the reforms to the public.

“The centrepiece of the reforms is giving power to the doctors, on the basis that they know what is best for health. The reasoning goes that doctors have an unrivalled knowledge of NHS in England. Now the same doctors are saying these reforms present a substantial threat to health care in this country. Lansley and co can’t have it both ways. Doctors are either the trusted guardians of the NHS, or they are not.…Past experience of GP commissioning has been patchy and mixed, showing GPs to be costly and unenthusiastic commissioners of health. Current worldwide experience of unrestricted private competition has shown it to decrease fairness in health provision.” –  http://www.labourlist.org/when-the-facts-are-on-your-side-argue-the-facts

The British Medical Association recently announced they completely oppose the new NHS reforms.

Firstly they complain that doctors, nurses and health professionals have no choice in the NHS reforms, which completely opposes the ‘selling point’ the government has been using.

“The BMA also argued there was “no electoral mandate” for the reforms as the plans were not part of the election manifestos put forward by the Conservatives or the Liberal Democrats, whose members voted against reforms at the party’s spring conference, calling them “damaging and unjustified”. – http://www.guardian.co.uk/public-leaders-network/2011/mar/15/bma-doctors-vote-against-nhs-health-reforms

Doctors around the UK are protesting against NHS reforms, saying they are ill thought out and that the reform amounts to privatization.

“The government’s health reform plans have suffered a damaging blow after the BMA voted to support scrapping plans to overhaul the NHS.

An emergency meeting held on Tuesday by the doctors’ union and attended by close to 400 members to debate support for the health and social care bill now going through parliament voted in favour of calling on health minister Andrew Lansley to withdraw the bill entirely and for a “halt to the proposed top-down reorganisation of the NHS”

Hamish Meldrum, chair of the BMA, said Lansley’s plans could have “irreversible consequences” on the organisation and on patient care.

While Meldrum acknowledged that involving doctors more in decision-making and more information for patients was a good thing, “on so many occasions, it’s the reality not the rhetoric that counts and it’s the reality that is causing all the problems” he said.

He added: “What we have seen is an often contradictory set of proposals, driven by ideology rather than evidence, enshrined in ill thought through legislation and implemented in a rush during a major economic downturn.”

“An earlier promise, made before he was elected, by prime minister David Cameron to protect jobs within the NHS have also previously been criticised by the BMA. The group said PCTs risked collapse as they had been losing staff, despite not yet being fully scrapped.

Among further criticisms the group said Lansley had used “inaccurate and misleading information to denigrate the NHS” by comparing UK cancer and heart disease rates with those in Europe.”

http://www.guardian.co.uk/public-leaders-network/2011/mar/15/bma-doctors-vote-against-nhs-health-reforms

BMA, BMJ, Unions, doctors and nurses have made a number of complaints:-

Lansley claims to have evidence but has none –

“Both Lansley and Cameron overstate our mortality figures to claim that the NHS is failing. Everyone wants more improvement, but money does not produce an immediate and visible reduction in mortality from one thing. Interventions take time to have an impact, especially on things that kill you slowly, and treatment isn’t the only factor affecting how many people die of something. But to take just two things, mortality from cancer has fallen every year since 1995, and heart attack deaths have halved since 1997.

The government claims that our rate of death from heart attacks is double that in France, even though we spend the same on health. Health economist John Appleby instantly debunked this claim in the BMJ, and his piece will become a citation classic. From static 2006 figures in isolation the government is right: but the trajectory of improvement in the UK is so phenomenal that if the straight line continues – as it has done for 30 years – we will be better than France by 2012.”

http://www.guardian.co.uk/commentisfree/2011/feb/05/lansley-use-word-evidence

“In its section on GP fundholding, this “thorough analysis” ignores the four peer-reviewed academic papers I described last week, which sadly found no evidence of an overall benefit from GP fundholding. It makes a series of five assertions about outcomes, though these are unreferenced to any paper at all. I contacted the Department of Health, which ferreted out the sources: there was just one, a document from the King’s Fund. It is not a peer-reviewed academic journal article, but the King’s Fund are pretty good, in my view. If you read this document, it too finds that the results of GP fundholding were mixed: some things got better, some things got worse.

So the minister has cherry-picked only the good findings, from only one report, while ignoring the peer-reviewed literature. Most crucially, he cherry-picks findings he likes while explicitly claiming that he is fairly citing the totality of the evidence from a thorough analysis. I can produce good evidence that I have a magical two-headed coin, if I simply disregard all the throws where it comes out tails.”

http://www.guardian.co.uk/commentisfree/2011/feb/12/bad-science-ben-goldacre-nhs

Any willing provider = privatization and is ill thought out – “Government plans to let GPs buy from “any willing provider” are not sophisticated enough, report says” http://www.bmj.com/content/342/bmj.d2091

Too early to let Andrew Lansley’s monster out of the lab –

“What do you call a government that embarks on the biggest upheaval of the NHS in its 63 year history, at breakneck speed, while simultaneously trying to make unprecedented financial savings? The politically correct answer has got to be: mad.

The scale of ambition should ring alarm bells. Sir David Nicholson, the NHS chief executive, has described the proposals as the biggest change management programme in the world—the only one so large “that you can actually see it from space.” (More ominously, he added that one of the lessons of change management is that “most big change management systems fail.”1) Of the annual 4% efficiency savings expected of the NHS over the next four years, the Commons health select committee said, “The scale of this is without precedent in NHS history; and there is no known example of such a feat being achieved by any other healthcare system in the world.”2 To pull off either of these challenges would therefore be breathtaking; to believe that you could manage both of them at once is deluded” – http://www.bmj.com/content/342/bmj.d408.short

Irreversible step in the wrong direction –

“The group of 150 doctors said, in a letter sent to The Times, that the “wholesale re-engineering of the NHS and the destruction of PCTs” was expensive and unnecessary and said the bill represented an “irreversible step” towards privatisation.” – http://www.guardianpublic.co.uk/nhs-reform-bill-under-fire-from-doctors

Slash and burn approach –

“In a robust message to Lansley, the BMA adds: “We urge the government and NHS organisations to focus on those areas where they can truly eliminate waste and achieve genuine efficiency savings rather than adopt a slash-and-burn approach to health care, with arbitrary cuts and poorly considered policies.”

http://www.guardian.co.uk/society/2010/oct/01/nhs-reform-slash-burn-bma

The reforms scrap deaneries and have a negative effect on training –

“Tom Dolphin, co-chairman of the BMA’s Junior Doctors Committee, is alarmed at the abolition of the deaneries.

“[The health secretary] Andrew Lansley said several times in public that he was going to keep the deaneries, but that’s now turned into keeping the functions of the deaneries, which is not the same thing,” he says.

Ian Wilson, deputy chairman of the BMA’s Consultants Committee, agrees that putting individual trusts in charge of training is a mistake. He believes that it could lead to completely different training models springing up around the country.

“It’s not clear how that will allow the maintenance of standards and transferability of people’s skills and the ability to provide a service between different healthcare environments,” he says. “There could be limited transferability between regions.”

Dr Dolphin believes that trusts will find it difficult to plan for the long term, leaving juniors scrabbling around for suitable posts.

“The short term drivers are more powerful for trusts. Even if the trusts did come up with long term plans they will be drowned out by the cacophony of targets for the short term,” he says. “It will lead to boom and bust at a very local level.”

Patrick Cadigan, registrar at the Royal College of Physicians, agrees that handing over training responsibility to trusts is shortsighted.

“The difficulty with many trusts is trying to persuade them to give adequate weight to training issues,” he says. “We also have difficulties with trusts allowing physicians to be training supervisors and to take on more onerous education roles.

“There appear to be a lot of sweeping generalisations [in the consultation document], and there’s a lack of evidence on the performance of the current system.”

Dr Cadigan adds: “The timescale for medical training is long. Can workforce numbers really be looked at at a local level? We need to see a role for central bodies.”

http://careers.bmj.com/careers/advice/view-article.html?id=20002222

Reforms will distract doctors from the work that really matters  – http://www.bmj.com/content/342/bmj.d1974

The reforms are inadequate –

“NHS reforms need to take account of the accumulating evidence on the benefits of integrated care. As a recent critique of healthcare in the United States has concluded, the scale of the challenges facing health systems is such that disruptive competition between integrated systems is likely to be more effective in promoting desirable innovations than competition between fragmented systems.18 The same applies in England, where a much more nuanced debate is needed that recognises the possibility of integration and competition both having a part in improving performance. In this debate, the focus should be on the development of medical groups comprising general practitioners and specialists able to both provide and commission services.” – http://www.bmj.com/content/342/bmj.d905.full

The NHS Reforms are costly with no guarantee of improvements in services –

“One of the major long term aims of the restructuring is to achieve significant cost savings by removing layers of bureaucracy in the form of Strategic Health Authorities and Primary Care Trusts. On Monday the Health Secretary said that the reforms would see management costs (currently standing at £1.85 Billion) cut by 46% over the next four years (a saving of £850 million).

Due to the scale of the changes many experts believe that costs will spiral out of control. In the British Medical Journal one expert said that the current £1.7 Billion fund could end up increasing to £2-3 Billion. While in the Lancet Kieran Walshe, professor of health policy at Manchester Business School said the reorganisation is likely to cost up to £3bn to implement with no guarantee that it will improve performance or lead to better care for patients.” – http://www.commonwealthcontractors.com/news.php?id=541

The reforms will lengthen waiting lists –

“The Government’s massive restructuring of the health service is likely to drive up waiting lists at a time when they are already under pressure from a vacancy freeze in the NHS. That is the warning coming from the Chartered Society of Physiotherapy (CSP”) – http://www.csp.org.uk/press-releases/2011/01/19/nhs-reforms-could-compound-waiting-list-woes-patients-say-physiotherapists

It is increasingly clear that all of the evidence suggests that the reforms will take power from doctors, nurses and patients and give power to big businesses.

Many, including Michael Moore and the website ‘false economy’ argue that the reforms will increase debt, which will increase homelessness, which will increase crime. Health insurance debt is the #1 cause of homelessness in America – http://falseeconomy.org.uk/blog/1-april-2011-all-together-for-the-nhs

Amongst other complaints:-

http://www.bmj.com/site/nhsreforms/index.xhtml

http://www.bma.org.uk/healthcare_policy/nhs_white_paper/index.jsp

I think everyone agrees that taking advantage of the vulnerable is wrong, the problem is when people fail to see that profiting on ill health is exactly that.

If the government says Doctors know best how to run the NHS then why are they ignoring the unanimous opposition to these reforms?

I don’t want to put the health of my family, my friends, my loved ones, my future children and grandchildren, all future generations, the health of my country into the hands of investors who will be obliged to do what they can to maximize profits – not deliver satisfactory health care.

Yours sincerely,

Vince.

Austin Mitchell MP kindly responded to my e-mail with a written letter. He says that he is “pleased that the pressure of public opinion, the opposition and the voices of professionals have caused them to pause and, I hope, think again, because the top down reorganisation implicit in the Bill, that is now halfway through it’s passage in the House, was heading for disaster” His viewpoint is that “it’s disastrous to combine a massive economy drive with full scale reorganistion. The economies demanded in the so called efficiency savings were too great and would not only stop the improvement, which has occurred over the last few years, in its tracks, but lead to staff reductions and set the whole NHS back three years” He says the PCT system was working well and there is little point in scrapping it and that this pause should be a genuine rethink and not just a listening exercise before going ahead with more of the same. He also states “The further intrusion of the private sector is unacceptable, as is the downgrading of the hospitals” and continues “The government will just have to face up to the fact that it’s no good just maintaining Labour’s spending levels. Spending has to increase because inflation in health is high, we have an ageing population and the costs of the technology is steadily increasing” and apparently he will be sending my letter to the Minister as it’s more important that he be made to listen as Austin Mitchell already agreed with my argument.

I’d call that a win.

What does your MP say?

http://38degrees.org.uk/page/content/nhs-mps/

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