Wednesday, 1 December 2010

Keep our NHS Safe!

Wilson with the enchanting MP Caroline Lucas (Leader of the Green Party- we are not worthy!)
Images of Room 14 in Parliament House (a small debate room - almost the same size as our local council chamber...!)
It was surreal experience being in a place of such authority.
At the end of a productive meeting!
Pictures could not be taken through most of the House, but the main area though plain in design had a striking full beamed roof and seeped with reverberating power.

 Yeah that's me - oh and behind me you can see that even politicians get into festive mood!
 Some of the non-photograph areas had ornate finishings, here is one area in the photograph area that indicates the elaborate and exquisite detail that pervades the house.
Imagine this view as you left your place of work....

Wendy Savage from Keep our NHS Public in conjunction with Jeremy Corbyn MP, Gail Cartmail, (Unite); Jacky Davis, (NHS Consultants’ Association); Caroline Lucas MP, and  Jonathon Tomlinson, (Hackney GP), organised an important seminar on The White paper on Health Equity and Excellence: Liberating the NHS published on 12 July 2010.  Keep NHS Public state that the paper "poses a major threat to the NHS"  This paper is being pushed through by our ConDem coalition Government. 

The seminar raised much heated  discussion - all those in attendance agreed that a priority for the campaign against the White Paper, was to organise a parliamentary group of opposition MP's who would spearhead a challenge and be our voice in Parliament.. 

Despite several searches, I noted MP Mike Gapes was missing and was disillusioned by this. It was however, amusing and rather alarming, when a member of the public insinuated that our Labour MP's might not be opposed to the plan.  This assumption was based on the program of attrition by stealth, that has been imposed upon the NHS under the previous Government.  They outsourced much of the minor treatments to private "treatment centres"  during their last term in power.  Moreover their disastrous "Private Finance Initiative" (PFI) has resulted in our NHS being indebited to private companies.  All of whom, seek profit by charging extortionate interest on property "leased" through these agreements.  The deal is made more sordid when you consider the buildings will eventually return to the more wealthy landlords with even bigger assets! 

The white paper is attempting to terminate the existing NHS structure and subvert the work of the PCT, whilst creating new practitioner consortiums.  The medical elite will soon be paid even more to run their own private NHS businesses.  This bodes ill for the future of the NHS and can only be a huge step towards extinction of our much loved publicly owned NHS.

What future are we leaving our offspring?  Ramped up student loans and expensive further education costs, Private medical health, increased crime a consequence of reduced policing, and no real jobs to fund any of the above!

Caroline Lucas MP Leader of the Green Party attended the event.  She has kindly reproduced her final address at the seminar (sic):

Speech for Keep our NHS Public seminar – November 2010

Green Party response to White Paper

Thank you and I appreciate this opportunity to give you an overview of my Party’s response to the Health White Paper, a Paper I think we are all agreed makes clear the coalition’s intention to forge ahead with the commercialisation of the health service.

The previous government took us some considerable way in this direction and there is already significant evidence that such an approach does not benefit patients or the NHS. For example, a 2010 National Audit Office report questioned the long-term value for money of PFI hospital contracts and found that the lack of flexibility in repaying debts could make it difficult for trusts to make savings without cutting back on services.

Increasing the role of the market in the NHS will not make it more efficient, nor make the NHS more responsive to patients needs.

Instead, an increased role for the market will fragment care and increase the costs of provision.

As any economist will tell you, markets need mechanisms to operate. For the NHS, that means increasing the number of managers and accountants, which will result in a cut in front line services, just the opposite of what Andrew Lansley has announced he wants.

By expanding the role of the market, handing powers to consortia of GPs, privatising hospitals, and scrapping important targets, the Secretary of State for Health is creating the perfect conditions for high costs, poor practice, unaccountability and long waiting lists.

Colleagues will be aware that the coalition’s plan for GP commissioning is one aspect of the proposed reforms that has attracted considerable attention – and controversy. Much has been said about the conflict of interest of GP provided services being commissioned by GPs. We endorse this concern.

We also consider that increasing the number of commissioning bodies will increase administration costs. There is no reason to believe that a threefold increase in the number of commissioning organisations will not lead to a threefold increase in administrative costs. These increased costs will reduce the amount of money available for front line care – despite promises to protect that care.

Increasing the number of commissioning bodies will also serve to dilute health care planning skills. Whilst some GPs may have these skills, overall they are in short supply and neither the proposed structure nor the existing structure addresses this problem.

Health care planning skills have also changed over the past two decades to become a contracting function, reducing the need to understand health and increasing the need to understand trading – again GPs are not best placed to fulfil this role and the expectation is that many will instead form consortia.

We believe that the risk here is of secondary and tertiary care consultants and other clinical colleagues being excluded from the decision making process, and of financial outcomes taking priority over the best clinical outcomes.

Moreover, planning on a small scale is commensurately harder than planning on a wider one and with the dilution of this skill across commissioners, the likelihood of poor planning may well increase.

Training and education also benefits from a broad overview of workforce requirements – as the British Medical Association point out “increased reliance on local planning and management of education and training” could result in “further instability to patient care”.

And what happens if GP consortia, for example, fail. The white paper states that there will be no bail outs, but not what will happen instead. Will they be replaced with another consortium composed of exactly the same GPs? How will patients access services in a true business model if their local hospital is not funded? Again, this makes planning hugely complex and, without a system wide approach to ensuring continuity of health care provision, there is a very real danger that poorer areas will suffer drastic reductions in provision.

Increasing the number of commissioning bodies will also introduce instability into an NHS that is already facing a huge financial challenge – in the shape of £20bn of cuts.

And despite what the Conservatives and Liberal Democrats tell you neither will it end the current post code lottery by reducing the variation in services across the country. On the contrary - the proposed changes will increase the level of local decision making that directly leads to this so called lottery, and the White Paper lacks any assurances or policies about how this will be avoided.

Indeed despite being highly critical of the fact that some people are denied health care that they might receive if they lived in a neighbouring town, the White Paper contains no concrete proposals to resolve the problem.

Implicit with increasing the post code lottery and with the introduction of the business model for providers is the creation of a two tier NHS. More affluent people will be able to top up care whereas poorer people will not.

This, as we know, is dressed up as offering patients more choice. Choice underpins the government’s plans for a market in the NHS, despite all the evidence showing that what patients really want is access to good local services. In other words, although the very concept of the market is based on a principle that is fundamentally flawed we are being sold it anyway.

The market approach to health care is as indelibly and comprehensively embedded in this White Paper as the words through a stick of Brighton rock.

GP commissioning will result in increased spending on private companies providing commissioning support and this is combined with the move to a fully privatised / social enterprised NHS.

The Green Party is fundamentally opposed to the concept of the market approach to health care. We believe that health care should be a public service based on collaboration and cooperation between health professionals and their patients, rather than a competitive purchasing based system that relies on a range of businesses to provide health care.

Expansion of the market will increase cherry picking of care and damage core providers such as hospitals. Private providers are primarily concerned with profit rather than patient care or training professionals. It is wrong for taxpayer’s money to go into the pockets of shareholders, especially when it is done at the detriment of our NHS.

There is also no indication about how core services will be protected. We are concerned the local people should continue to have care at the point of need and that care should be provided locally, as patients are often unable to travel long distances.

We also believe that a market based approach will significantly reduce transparency and accountability. Introducing local government involvement in public health is welcome but the rest of health care provision and commissioning is being moved even further from democratic mandate. This is a core weakness in the white paper.

Tellingly Andrew Lansley does not have the backing of the health profession, many of whom fear the fragmentation of the NHS and have raised concerns that the biggest shake up since its inception will not result in better patient care. There is also the continuing uncertainty over ideas such as allowing hospitals to compete for patients on a cost of treatment basis – a dangerous move which will effectively privatise, not just commericalise, hospitals.

The Health Secretary’s announcement today on public health - including plans to tackle obesity, repackage cigarettes, introduce minimum pricing for alcohol and increase physical activity – is sadly lacking in detail or much of a budget, just 4 billion, a tiny proportion of the NHS overall spend. However, it is crucial that health promotion becomes much more of a priority and that the various white papers are properly integrated to put people’s health first.

Before finishing I’d just like to very briefly flag one further concern the Green Party has with the Health White Paper - the suggestion of local pay negotiations and bargaining. This will be hugely damaging, both in terms of medical staff’s terms and conditions and in the knock on effect for patient care if market forces are allowed to dictate quality and quantity of provision.

As is often the nature of responding to someone else’s proposals it is all too easy to focus on what is wrong – and not put forward alternatives. I hope however, that you are left in doubt that the Green Party does have a clear alternative to the proposals laid out in this White Paper. It is called a publicly funded, publicly provided health service – a national health service.

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