NHS Reforms in UK

Received this email today, it is worth posting:

Dear friends

You know I wouldn’t normally write to you about such things but many of my expert colleagues have been gathering evidence over this past year about the changes proposed in the Health and Social Care Bill and their findings worry me greatly.  So I have taken the liberty of writing because I am now fully convinced that the Bill may end up by commercialising health care in this country. It reminds me of the way in which we lost much of our NHS dentistry the UK.  Worse, even if not deliberately setting out to do so, it looks as if the Bill will push the NHS towards a system resembling the USA’s – and if that doesn’t worry you, please read on.  

Almost everyone I know connected with the NHS has had concerns of one sort or another about the Bill. See for example the Royal College of GPs survey of over 2500 GPs published last week in which nearly all of them thought bill should be withdrawn.

It’s surprising how few people are taking the debate seriously even though it’s been going on for well over a year. In what follows, I have summarised just a small part of the evidence that has recently struck me (the links are underlined so you can click on them to find out more).  There’s lots more where that came from, believe me!  If you find the summaries useful I hope you will spread the word to as many people as you can. The more people know what’s being done to the NHS, the greater the chance of minimising the damage. It would help if you could also write to your MP.  

It’s not too late to change things if we spread the word more effectively, and we must surely do that, not least as there is now to be a debate in parliament on Monday 16^th, and it is still possible for the House of Lords of Lords to intervene.  

Did you know that the Secretary of State is still holding out on the House of Lords by not revealing the contents of last year’s “Transition-Risk Register” a Department of Health report that was drawn up over a year ago to show the risks of continuing with the Bill? The Risk Register has never been released, despite two instructions from the Information Commissioner to do so. Why are such relevant facts being withheld from the Lords, from parliament and from the rest of us? What’s being hidden?

Perhaps the Risk Register agrees with the available evidence, most recently cited by OECD, that the proposed changes may actually reverse the recent progress made by the NHS and make things worse.

Many believe that the competition of a market system improves health care. In fact the reverse is probably true, as research overwhelmingly shows. For instance, there is an incentive in market systems to do unnecessary work.  In the US system, which is the most similar to the one we seem to be moving to, The Economist estimates that 10%-12% of all 2009 health care expenditure went on unnecessary treatment. Privatised systems also require higher management and transaction costs (e.g. for billing). Believe it or not,  international comparisons show NHS management costs to be among the lowest.

Of course our current system has its problems, but what country’s doesn’t? We keep hearing how bad UK cancer care is, for example, compared to other countries. Yet outcome measures have improved markedly in the last decade. Another example: a recent OECD report showed that the decline in avoidable mortality in the UK was the second fastest of all industrialised countries.  A 2011 study shows that the NHS was among the most cost-effective healthcare systems among 17 countries (the USA was among the worst). Another shows that satisfaction with the NHS is at an all-time high. It’s strange, then, that the media and politicians feed us the opposite picture with a constant stream of stories about the NHS’s flaws. Is that because a cornerstone of the government’s argument for pushing the Bill through is the NHS’s allegedly poor outcomes?

They say that the Bill will put GPs in charge of commissioning health service on behalf of their patients (e.g. drawing up contracts with the local hospitals). But the GPs new Clinical Commissioning Groups (CCGs) will need help to do that. Many are turning to private consultancies to get that help. Some of that commissioning support is to be delivered by insurance companies, potentially the very same insurance companies that have had such a malign influence on healthcare in the USA.  As you may know, quite apart from 50.7 million US citizens who can’t afford the premiums, US insurers ruthlessly ration care, limit doctors’ clinical freedom and often use the small print to refuse to pay out.  It seems that these companies are positioning themselves to run large parts of the NHS in future. Is this really what we want?

So why this upheaval, which the electorate never asked for and which is already happening even before the Bill becomes law? (In my own NHS work I constantly hear how the running of the service is already in “meltdown” thanks to these changes.) It is not by any means unstoppable if we all make enough fuss.  If you want to know more you can follow the links above, and also go to http://abetternhs.wordpress.com/faq/ for a clear statement of the evidence on much else about the Bill.

If all of this makes you as worried as me, please pass the message on in any way you can. Feel free to copy parts of this letter to your friends, your MP and anyone else you think needs to know.

It’s not too late to stem the damage.

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John Gabbay
Emeritus Professor in Public Health
1 Daniells Close
LYMINGTON SO41 3PQ