• Lords resumes debate on the Bill
  Rally outside Parliament Weds Feb 8: 2.30-8.30pm

  Tuesday 31st January 2012
  
  Hackney Keep Our NHS Public (KONP) have received permission to hold a rally outside Parliament on the day that the Health and Social Care Bill is to reach report stage - Wednesday 8th February.
  We ask that you let all your members know about this demo. We ask that all those who might be in the area support this demo - either in person or by promoting it as widely as possible.
  THIS IS A DEMO FOR EVERYONE WHO OPPOSES THE BILL.
  Please bring your placards and banners etc.
  Where: Old Palace Yard, Westminster, Opposite the Lords
  When: 2.30 - 8.30 p.m. on the 8th of February.

• Lord Owen steps in on Health Bill after Commons “misled”
  What’s Lansley got to hide?

  Thursday 12th January 2012
  
  Former Health Secretary Lord Owen has stepped up the fight to force Andrew Lansley to release a potentially damning “Risk Register” compiled by Department of Health officials, assessing the controversial Health and Social Care Bill, which Lansley has withheld from MPs and peers since this time last year.
  
  Lord Owen, who tabled a motion on the Risk Register last month in the Lords, has now written personally to the Presidents of the medical Royal Colleges warning that the dangers of proceeding are far greater than those of stopping the Bill now. Ministers have been encouraging the DoH to implement aspects of the Bill even before parliament decides, to make it seem a “done deal”.
  
  Publication of the Register was first requested under the Freedom of Information Act last February: but Mr Lansley has flouted the law and defied two instructions from the Information Commissioner to release the document. According to the Evening Standard:
  
  “Mr Lansley's officials had argued that releasing the Risk Register, when the Standard put in its FOI request in February with debate raging over the NHS changes, would have "jeopardised the success of the policy".
  
  Almost a year later the Register still has not been released. The Information Rights Tribunal has not yet ruled whether the government's appeal will be heard, or fixed a date for a hearing, but in the meantime the Risk Register has been consciously kept under wraps for the entire duration of the Commons stages of the Bill, leaving MPs to vote time and again in ignorance of the findings. And it has also been withheld from the Lords during its debates, despite further attempts to force its release.
  
  This secrecy confirms suspicions of opponents of the Bill that the document reveals some of the many weaknesses in Mr Lansley’s proposals for greater private sector involvement and competition in the NHS, and for the Secretary of State no longer to be accountable to Parliament for a fragmented NHS run nationally by an unelected Commissioning Board, and locally by private sector management consultants, who will be steering the “Clinical Commissioning Groups”.
  
  The danger is that the risks identified in the register, and many proposals in the Bill itself, could escape any scrutiny in parliament, with the pitfalls of the Bill exposed and felt by patients and the public only after the Bill becomes law.
  
  Campaigner Dr John Lister, a health policy expert at Coventry University, said:
  
  “What has he got to hide? Mr Lansley has cynically attempted to mislead MPs – most of whom have no idea what the Bill says, but have voted on party whips – by withholding this document. He is now trying to do the same with the House of Lords.
  
  “Lansley’s plan is not just lacking any supporting evidence: it is being pushed through with damning evidence suppressed. This is taking a massive risk with patient care.
  
  “If our own Parliament won’t uphold the law on Freedom of Information, or demand the full facts, it speaks volumes on our flimsy democracy.”
  
  FURTHER DETAILS: Dr John Lister 07774 264112, john.lister@virgin.net
  
  Campaigners fighting on to try to prevent Lansley’s Bill reaching the statute book include hospital consultant and BMA Council member Clive Peedell who is staging “Bevan’s Run” from South Wales to London His route started at Bevan’s birthplace in Cardiff yesterday (January 10), passing through David Cameron’s Witney constituency on Friday January 13, and ends in a bedpan race down Whitehall on the 15th. There will be rallies at each staging post: why not join Clive and colleagues for your nearest rally, or even for the run? http://bevansrun.blogspot.com/p/details-of-run-with-maps.html
  
  Clive Peedell cliveypeedell@hotmail.com

• Public Health for the NHS
  Lansley’s NHS market could wind up like social care

  Tuesday 10th January 2012
  
  PRESS BRIEFING: Health & Social Care Bill
  
  While David Cameron and ministers talk misleadingly about “integration" of services for older people, the real danger is that the shambolic state of elderly care could be replicated across the whole of the NHS if Andrew Lansley’s controversial Health and Social Care Bill is rubber-stamped by the House of Lords.
  
  The Bill would fragment and “dis-integrate” the NHS: but the disintegration of social care has been taking place over the last 20 years.
  And the threat is that NHS care which is now free at point of use could be “integrated” with the failed social care system, which levies extensive means-tested charges – killing off the NHS as we know it.
  
  Recent reports by Age UK and the King’s Fund on the crisis in elderly care have shown that 800,000 frail older people today are lacking services they need, rising to 1 million by 2015, while the Local Government Association recently warned ministers that the system of high-cost social care is “not fit for purpose”. BBC reports have exposed a growing problem of “bed blocking” and now hospitals are under pressure to discharge elderly patients despite the inadequate arrangements to care for them thereafter.
  
  This competitive market in social care was created 20 years ago in sweeping “reforms” initiated by Margaret Thatcher. Until 1993, NHS hospitals were responsible for much long-term care, delivered free to all at point of use, funded from taxation, while those needing nursing home care had their fees covered by social security.
  
  Now, with most NHS specialist elderly care beds having closed, and social care delegated to local government social services, patients are left dependent on costly, largely privatised domiciliary care, and privately-run residential care and nursing homes " – while many more frail older people are excluded from any support by arbitrary “eligibility criteria” operated by cash-strapped councils facing 28% cuts over 3 years, and by local Primary Care Trusts.
  
  Elderly care is under-funded, fragmented, uneven, unequal and unsatisfactory, with responsibility split between local health and council commissioners, while 80% of domiciliary care is now privatised, and many care homes are run for private profit.
  
  In this “market” vulnerable people are forced to “choose” between a multiplicity of low quality providers, who cherry-pick certain services and ignore others, leaving gaps in care. Pay and conditions for staff are notoriously poor, contributing to a demoralised, perfunctory service and the neglect of vulnerable people.
  
  Competition has not brought improvements but has added new problems: elderly care is marked by poor contract management, sloppy and/or partisan commissioning, loose standard-setting, inadequate inspections, and rising charges as the remnants of public provision are replaced by a burgeoning private sector.
  
  And while the profits remain in private hands, any failure by private providers – such as the private equity firm that bankrupted the Southern Cross nursing home chain – lands back on the public sector, which has to step in and rescue the victims.
  
  The social care system is already becoming little more than a bare-bones service for the less well-off, with massive local variation and widening health inequalities. A similar fate is likely to befall the NHS if the current changes are implemented.
  
  Mr Lansley’s plans for the fragmentation of the NHS involve disbanding its existing organisational structures, and rather than replacing them, turning over service coordination to the market’s “invisible hand”. The plans are devoted to opening up much greater involvement of private companies to deliver services paid for by the taxpayer; they include denationalising NHS hospitals as fast as can be managed. This threatens to fundamentally change, undermine and destabilise the health service.
  
  The new system would be as poorly regulated, as patchy and incomplete, and as much of a postcode lottery as social care. It would allow private medical corporations or “any qualified provider” to scoop up profits – but dump all of the complex and costly cases onto publicly funded hospitals, for as long as such organisations exist.
  
  It would even allow local Clinical Commissioning Groups to designate some services as outside the NHS, making them subject to fees and charges for the first time since 1948.
  
  London GP Jonathon Tomlinson said:
  
  “If you want to know what a market in health care would look like, just look at elderly care – or dentistry, where charges are rampant, the private sector rules the roost, and many people cannot find an NHS dentist. Now GPs see many patients with dental problems. The NHS leads the world in fair access to care: Lansley’s Bill would undermine that.”
  
  Lancashire GP and BMA Council member Dr David Wrigley adds:
  
  “Our NHS was making real progress before Andrew Lansley’s Bill, and recognised as one of the best in the world: the danger is that it could become as unfair and chaotic as care of the elderly.”
  
  Mr Lansley has the support of only a tiny minority of GPs and doctors for his Bill, which was not put before the electorate last year. His plans have been actively opposed by health workers and criticised by a wide range of think tanks and pressure groups for patients.
  
  Now a succession of feel-good government “initiatives” and announcements are being used as red herrings to divert the media and public while this retrogressive legislation is forced through the House of Lords.
  
  That's why David Cameron is now suddenly declaring himself an expert on nursing rotas and prattling about improved standards even while thousands of nursing jobs and support staff are axed, wards closed and services rationed.
  
  Campaigners will be fighting on to try to prevent Lansley’s Bill reaching the statute book, including hospital consultant and BMA Council member Clive Peedell who is staging “Bevan’s Run” from South Wales to London His route starts at Bevan’s birthplace in Cardiff today (January 10), passes through David Cameron’s Witney constituency on Friday the 13th, and ends in a bedpan race down Whitehall on the 15th. There will be rallies at each staging post: why not join Clive and colleagues for your nearest rally, or even for the run? http://bevansrun.blogspot.com/p/details-of-run-with-maps.html
  
  FURTHER DETAILS:
  
  Dr David McCoy d.mccoy@ucl.ac.uk
  
  Dr David Wrigley dgwrigley@doctors.org.uk
  
  Dr Jonathan Tomlinson echothx@gmail.com
  
  Clive Peedell cliveypeedell@hotmail.com
  
  Dr John Lister 07774 264112, john.lister@virgin.net

• BMA opposes the whole of Lansley's Health Bill!

  Friday 25th November 2011
  
  BMA press release : BMA Council opposes plans to 'privatise' commissioning support
  For immediate release: Thursday 24th November 2011
  
  BMA Council today (24/11/11) called for the withdrawal of government plans that are likely to lead to support services for clinical commissioning groups (CCGs) in England being provided solely by large commercial organisations after 2016. An urgent meeting has been requested with the Secretary of State for Health to raise the BMA's concerns.
  
  Draft guidance from the Department of Health - Developing commissioning support: Towards service excellence - makes a number of recommendations about how clinical commissioning groups should function, including how they should access technical and "back-office" support, such as analysing sensitive population data.
  
  Current primary care trust (PCT) clusters are forming commissioning support units and, from 2016, would be encouraged to form social enterprises and partner with the private sector, rather than remaining part of the NHS family. Commercially-focused criteria to determine eligibility for providing commissioning support would also be introduced, making it almost impossible for CCGs to have their own, in-house support staff.
  
  Dr Hamish Meldrum, Chairman of BMA Council, said: "A key plank of the government's NHS reforms was to entrust GPs and other health care professionals to lead on the commissioning of services for patients to ensure local health needs were met. These latest proposals from the government have the potential to seriously undermine this role, restricting the freedom and independence that clinically-led commissioning groups need to make locally sensitive, locally accountable, patient-focused decisions.
  
  "Doctors tell us about the chaos they are already seeing on the ground as more and more change is implemented. The government should be focusing on ensuring the skills and experience of staff in current PCT clusters are retained. They will be invaluable in supporting the development of CCGs and providing much needed continuity during this period of huge financial pressure and structural overhaul.
  
  "We will be urging CCGs to urgently review and where necessary change their structures to ensure they are able to fulfil their statutory functions without becoming dependent on external commissioning support."
  
  Following these deliberations, Council took a decision to oppose the whole Health and Social Care Bill, passing the following motion:
  
  In view of the implications of the recently published DH document 'Developing Commissioning Support: Towards Service Excellence', BMA Council
  - publicly announces its opposition to the whole Health and Social Care Bill
  - calls for rapid organisation of a public campaign of opposition to the Health and Social Care Bill.
  
  The BMA will be considering its next steps as part of its continuing activities on the Bill

• House of Lords briefing on the Health and Social Care Bill 2011,
  by Allyson Pollock and colleagues

  Monday 24th October 2011
  
  Health and Social Care Bill 2011
  House of Lords – Committee stage, 25 October 2011
  
  BRIEFING ON CLAUSE 1
  Prepared by
  Allyson Pollock, professor of public health research and policy, Queen Mary, University of London
  David Price, senior research fellow, Queen Mary, University of London
  Peter Roderick, public interest lawyer
  Tim Treuherz, retired head of legal services, Vale of White Horse District Council
  
  22 October 2011
  1. Introduction
  
  The Committee stage of the Health and Social Care Bill begins on Tuesday 25 October 2011, with consideration of Clause 1.
  
  Clause 1 impacts on the legal framework underpinning a comprehensive and universal national health service.
  
  The briefing is intended to assist peers supporting any of the amendments designed to restore the current statutory framework, although our preferred option is to omit Clause 1 and revert to the wording of the National Health Service Act 2006.
  
  In three sections below, we outline the legal effect of Clauses 1 and 10 on the Secretary of State’s duties, set out our concerns and questions relating to their impact on patients and services, and conclude with the key health policy issues raised by these clauses.
  
  [The briefing does not discuss the various amendments that have been tabled to Clause 1. Readers are referred to a legal analysis of these undertaken on behalf of 38 degrees. Our preference is to omit Clause 1 and to revert to section 1 of the 2006 Act.]
  
  2. The legal effect of Clauses 1 and 10 on the Secretary of State’s duties
  
  Clause 1 of this Bill proposes to change the fundamental legal basis of the NHS in England which has been in place since 1946. This is unacceptable to many.
  It was:
  • not mentioned in any manifesto
  • not voted for
  • not part of the coalition agreement.
  
  Under section 1(2) of the 2006 Act, the Secretary of State must provide or secure the provision of services in accordance with the Act for the purpose of promoting a comprehensive health service which s/he has the duty to promote under section 1(1). Under section 3(1) of the 2006 Act, s/he must provide throughout England, to meet all reasonable requirements, the key NHS services that are listed in that subsection, such as medical, nursing and ambulance services, and hospital accommodation.
  Clause 1 proposes to change section 1(2), so the Secretary of State would no longer have the duty to provide or to secure provision of services in accordance with the Act, but would have to exercise his or her functions so as to secure that services are provided in accordance with the Act. In addition, Clause 10 proposes to change section 3(1) so that the Secretary of State’s duty to provide the key NHS services throughout England will be replaced with a duty on the scores – indeed perhaps hundreds – of individual clinical commissioning groups (CCGs) to make arrangements for provision for persons for whom they are responsible.
  
  One of the key problems with these changes – and this was picked up by the Constitution Committee – is the severance problem. If the government has its way, the body with the duty to promote a comprehensive health service will not be the same as the body which has to make arrangements for provision. At the moment, as Lord Woolf said in the Court of Appeal in the Coughlan case, the Secretary of State “has the duty to continue to promote a comprehensive free health service and he must never, in making a decision under section 3, disregard that duty”. The scores of CCGs will not have that duty.
  
  The government has tried to argue in Earl Howe’s letter to Baroness Jay on 10 October 2011 in response to the Constitution Committee that the CCGs will have to have regard to that duty. But the Bill does not say that, and it does not give CCGs that duty.
  
  The government keeps saying that currently the Secretary of State does not actually provide and everything is delegated to the primary care trusts. But this is not the point. Section 3(1) is a unifying duty applying throughout England, and everything flows from that. If that starting point is discarded, then the core part of the current statutory basis for the NHS will also go.
  
  3. What will this mean for patients and services?
  The implications for patients and services can be considered in four respects.
  Firstly, the Secretary of State’s duty to provide is throughout England, and the PCTs and strategic health authorities are area-based, and these areas are contiguous. The CCGs will be ‘person-based’ or ‘group-based’, largely drawn from GP registrations, but neither the area nor the population are clearly defined. CCGs are supposed to cover all of England (Clause 22: new section 14A(2)), but there is no requirement that within the CCG all their patients live in one particular area, so a CCG area can comprise (say) a part of London, a part of Hampshire and a part of Cumbria. It is impossible to see how planning, monitoring of needs, and equity of access and service use can be safeguarded when the populations are segmented, fragmented and dispersed in this way.
  In effect, now, the entire population of a given area is covered by the NHS and PCT areas are contiguous. In future, this will not be the case: it will depend on what each CCG decides.
  Under current plans resource allocation formula will change from an area-based formula, to one based on GP registrations (GP lists) with all the problems that will bring. These problems which are well documented include, unstable denominators and numerators due to enrollment, disenrollment of persons and turnover of patients, complex risk adjustment methods, and incentives to risk select or cherry pick (McKee M et al. In defence of the NHS). This will adversely affect public health functions including the measurement of access to services, health service needs and equity of resource allocation and funding (Pollock AM, Price D. Submission to the Delegated Powers and Regulatory Reform Committee, House of Lords 10 October 2011)
  
  Clause 1, in conjunction with Clause 10, will therefore mean that patients in one particular area will not be provided for in the same way that they are at present.
  Secondly, each CCG will decide for itself what the reasonable requirements for services of those persons registered are. They will also decide (Clause 10(2)(b)) what services or facilities are appropriate as part of the health service for the care of pregnant women, women who are breastfeeding and young children (section 3(1)(d)); and for the prevention of illness, the care of persons suffering from illness and the after-care of persons who have suffered from illness (section 3(1)(e)). These two discretions given to each CCG mean there will be different provision for different patients with similar needs, depending on each particular CCG.
  The government says that this is the case under the PCTs now. But the crucial difference is that currently the core legal and unifying duty of the Secretary of State under section 3(1), linked to section 1(1) by section 1(2), is still in place. Currently everything stems from the Secretary of State’s duty to provide. In future, it won’t.
  
  Thirdly, because of the Secretary of State’s duty to provide, the PCTs are in effect responsible for everybody in their area, underpinned by the resource allocation formula. This will change, and what will happen in future is unclear to us.
  
  Under the NHS Functions Regulations, (The National Health Service (Functions of Strategic Health Authorities and Primary Care Trusts and Administration Arrangements) (England) Regulations 2002.) PCTs must make sure services are provided for people on GPs lists, and for persons usually resident in its area, or resident outside the United Kingdom who are present in its area, and who are not on GPs’ lists. And under, for example, The National Health Service (General Medical Services Contracts) Regulations 2004, the PCTs prepare and maintain GP lists, and can assign patients to them, subject to a dispute resolution procedure. In other words, although there is never 100% coverage, the intention is that the PCTs ensure that all residents within their geographic area obtain access to GP services and are registered with a GP.
  PCTs must also ensure that certain specified services must be provided for the benefit of everybody in a PCT area, namely (i) accident and emergency services and ambulance services, (ii) services provided at walk-in centres, (iii) facilities and services for testing for, and preventing the spread of, genito-urinary infections and diseases and for treating and caring for persons with such infections or diseases, (iv) medical inspection and treatment of pupils, (v) services relating to contraception, (vi) health promotion services, (vii) services in connection with drug and alcohol misuse, and (viii) any other services which the Secretary of State may direct.
  In future, a CCG will only be responsible for persons provided with primary medical services by a member of that CCG and those who usually reside in the CCG area (Clause 10(3): new section 3(1A)). Temporary residents, visitors, and workers not on those lists will not be covered. Regulations can be made to extend this (new section 3(1B)), and those regulations must cover everybody in the CCG area as far as facilities and services for emergency care are concerned (new section 3(1C)). Regulations may provide that some persons can be excluded from CCG responsibility, including those provided by a particular type of primary medical services (new section 3(1D)).
  We have a number of concerns with new section 3(1A) – (1D), which we have set out below in the form of questions that peers may wish to ask the government:
  • Why is CCG responsibility for persons not made definitive on the face of the Bill?
  • Who, in future, will have the task of ensuring all residents and temporary residents can be registered with a local GP? And what will happen if GPs refuse to accept, or strike off, patients? Who will allocate problem patients, and patients with learning difficulties, severe disabilities, or complex mental health or physical health problems? What about asylum seekers, and the homeless and those of no fixed abode?
  • Why is emergency care to be covered by regulations, not on the face of the Bill? Why are accident and ambulance services not mentioned?
  • Will any of the other services currently to be provided for the benefit of all people present in a PCT have to be arranged by the CCGs? It is intended that some services will move with public health services to local authorities, but the government should explain, category by category, what is to happen, and why is each of these services not also on the face of the Bill.
  • Why is it necessary to give the government the power to exclude some persons from the health service (new section 3(1D))?
  • More specifically, what categories of primary service provider does the government wish to be able to exclude from the health service? For example, new section 3(1D) would allow the Secretary of State to make regulations which took out of the health service persons receiving medical services under Alternative Personal Medical Services contracts – the one of the three basic GP contract types which is open to multinational health companies, such as United Health.
  
  Fourthly, we are concerned that services currently considered part of the health service by PCTs (under direction from the Secretary of State) will in future not be considered as part of the health service by CCGs – namely the six services and facilities referred to above for pregnant women, women who are breastfeeding, and young children, and for the prevention of illness, the care of persons suffering from illness, and after-care. If a CCG so decides, these might fall out of the health service. This would mean that the qualified guarantee of free access in section 1(3) would not apply, and so charges could be made for services that are currently free.
  This possibility arises because Clause 1 would amend section 1(3). At present, section 1(3) of the 2006 Act reads: “(3) The services so provided must be free of charge except in so far as the making and recovery of charges is expressly provided for by or under any enactment, whenever passed.”
  Under Clause 1, this would read: “(3) The services provided as part of the health service in England must be free of charge except in so far as the making and recovery of charges is expressly provided for by or under any enactment, whenever passed.”
  The proposed new section 1(3) should not be supported, and the government asked:
  • How will the government prevent services that are currently free for pregnant women, young children, and others (as above) from being charged for?
  4. Health policy issues raised by these clauses
  Clauses 1 and 10 of the Bill, considered together, demonstrate that the fundamental principle informing the Health and Social Care Bill is the substitution of the current mandatory system with a discretionary one.
  The net effect of the Bill’s provisions is that, unlike PCTs, which act on behalf of the Secretary of State, CCGs exercise functions in place of the Secretary of State and in the absence of a clear primary legislative framework. Thus, the Secretary
  of State is unable to discharge his or her duty to promote a comprehensive health service throughout England because the commissioning bodies which will control the majority (around 80%) of the NHS budget bodies do not collectively have a duty to cover all patients and in addition they have discretion over the services they provide and discretion to redefine eligibility and entitlements to NHS care. As a result there will be growing inequalities in access to care and NHS entitlements and erosion of progressive tax based funding for health care.
  Furthermore, the loss of area-based population responsibilities has serious implications for the stability and accuracy of measurement of needs and the equity of resource allocation and funding and service provision. This also affects the availability and nature of information to plan for health care needs and services and for monitoring access, service use, and health outcomes, all of which are essential to securing a comprehensive service.

• UCL students and staff protest Lansley Health Bill stitch-up

  Monday 17th October 2011
  
  To all those concerned with the future of the National Health Service,
  
  UCL Provost Malcolm Grant has just been named by Andrew Lansley as the preferred choice to head up the new NHS Commissioning Board.
  (http://mediacentre.dh.gov.uk/2011/10/14/lansley-names-preferred-chair-of-nhs-commissioning-board/)
  
  Malcolm Grant is not a clinician and has no experience in commissioning clinical services. A lawyer by training, he has presided over the outsourcing of UCL cleaning staff and supported the raising of the cap on tuition fees.
  
  This year, Grant was part of Prime Minister David Cameron's trip around the Middle-East, along with representatives of major arms companies.
  
  The choice of Grant as head of the NHS Commissioning Board seems to be based on his friendship with certain politicians and his reputation as an 'innovative' businessman, rather than on the best interests of NHS patients.
  
  The NHS Commissioning Board will be the body ultimately responsible for the NHS budget and, as well as directly commissioning some services for itself, will regulate the commissioning of services by GP consortia.
  
  On Wednesday afternoon, we want to make our opposition to the privatisation of the health service clear. We will object to the undemocratic appointment of Malcolm Grant, a supporter of privatisation, to a role of power within our health service.
  The government's plans for education and public health are now clear, and they come together in the person of Malcolm Grant.
  
  COME AND JOIN UCL STAFF AND STUDENTS TO DEFEND PUBLIC EDUCATION AND HEALTHCARE!!
  
  Wednesday October 19th at 1pm, Rally in the UCL Quad, Gower Street
  
  Facebook: http://www.facebook.com/event.php?eid=123237307783168
  
  Contact UCL Occupation: ucloccupation@gmail.com
  Call: 07742067280

• Over 400 public health doctors ask Lords to kill the Health Bill

  Wednesday 5th October 2011
  
  You may have seen an open letter to the House of Lords which was published in the Daily Telegraph on October 4th. That letter has now been signed by nearly 450 public health doctors and specialists calling for the Health and Social Care Bill to be rejected in its entirety.
  
  The full list of signatories which includes 33 Directors of Public Health; 21 Associate, Assistant or Deputy Directors of Public Health; 115 senior public health specialists and over a hundred professors with specialisations in the field of public health.
  
  Many public health specialists are formally trained in health economics and health systems policy and actively engaged in local authority and the NHS. This is the specialist health discipline that is perhaps most qualified to comment on the NHS reforms as a whole
  
  They believe that the overall package of reforms is harmful - at the level of the individual patient and at the level of the health system as a whole. Guided by the principle of fairness and the ethical foundations of the NHS, they oppose these reforms from a professional standpoint.
  
  A covering letter to the Lords who will vote on the Bill next week says:
  "
  We hope you will take our reservations seriously. We believe they are also felt by doctors and health professionals working in other specialities.
  
  "We ask you to oppose and refer the Bill to a Select Committee for proper scrutiny.
  
  Dr David McCoy, Professor Martin McKee, Professor Allyson Pollock, Dr John Middleton, Dr Paul Edmondson-Jones, Dr Christopher Birt, Dr Bobbie Jacobson, Professor Rosalind Raine, Professor John Ashton, Dr Alex Scott-Samuel and Professor Simon Capewell

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