 |
 |
 |
Campaigner's Diary
Articles from John Lister's regular column in the Morning Star, plus other articles for publication.
Treating MPs like mushrooms, Lansley's Bill relies on ignorance
(December 2011 Morning Star column)January 2012
Health Secretary Andrew Lansley is still defying the Information Commissioner and refusing to publish a potentially explosive "risk register" on his controversial Health & Social Care Bill - for fear it would scupper the Bill in the Lords in January.
In a cynical move, Lansley kept the report under wraps throughout the entire debate on the Bill in the Commons, and has now rebuffed efforts by the Evening Standard and others to force its publication under the Freedom of Information Act.
This level of desperation from the Health Secretary (who made a big deal of "open government" last year, when he noisily published the controversial McKinsey report outlining £20 billion of savings, after Labour ministers had refused to release it) indicates the extent to which Lansley knows he has lost the argument on the Bill. Its future hinges on Tory and Lib Dem peers and MPs continuing to accept their role as mushrooms (kept in the dark and inundated with sh*t) nodding through a Bill they have not read or understood, based only on "facts" and briefings from government spin-doctors, and ignoring all of the evidence to the contrary.
The huge Bill has already been extensively amended, although most of the damaging proposals remain intact. But the Lords vote on one crucial amendment, to restore the duty of the Secretary of State to provide comprehensive health services, has been put back to the new year - for fear of a government defeat.
Shadow Health Secretary Andy Burnham has offered Lansley a face-saving deal in which he would drop the Bill in exchange for Labour support in extending the commissioning role of GPs - but it's clear that Lansley has already gone too far down the road with the Bill to contemplate any concession.
At Burnham's initiative, Labour has belatedly launched a welcome, if fairly half-hearted, campaign against the Bill - but a useful starting point would be to engage the health unions, which so far remain focused only on the pensions issue, and have yet to wage any serious campaign to stop the Bill that could ultimately remove up to 1 million NHS staff from the NHS balance sheet (and pension scheme).
However the Bill has lost much of the naive support it initially was able to claim from the medical profession, with polls showing a massive 75% or more of GPs now opposed to key proposals, and just one in six of GPs willing to have any involvement with commissioning services.
Another worrying survey found overwhelming numbers of GPs concerned that they lack the necessary skills to carry out the commissioning role that they are supposed to have under the Bill.
And BMA's GP committee was enraged by a Department of Health November document making clear that the real plan all along was for GPs to serve as no more than a rubber stamp for plans and decisions to be taken by private companies carrying out the commissioning work.
The BMA's initial perverse decision not to oppose the White Paper or the Bill, but to maintain "constructive engagement" with the government on it, has been tested to destruction, with the government turning a deaf ear to the issues raised by the BMA and others - to the point where in November the BMA Council finally gave up, and changed its policy from merely calling for the Bill's withdrawal to opposing the Bill as a whole.
Meanwhile the wheels are starting to come off, even before the Bill becomes law. Even early enthusiasts for the idea of GP commissioning of services are now beginning to give up, and pull out of posts in Clinical Commissioning Groups because they do not have the time to do the extra work required. GPs have also been shocked to find that the management allowance will be just £25 per patient.
There are complaints that some CCGs are trying to cherry pick only the best performing and low cost GP practices, and exclude those whose prescribing and referral costs are higher because they cover deprived areas or older groups of patients.
400 public health doctors and academics have joined the fray, signing a hard-hitting open letter warning that the Bill could undermine the long term development of public health policy, and a survey of 1,000 public health experts by the UK Faculty of Public Health showed that a massive majority see the Bill as a "nightmare": 71% rejected Lansley's claim it would create a safer or more effective response to public health emergencies, 81% disagreed or strongly disagreed that the Bill would reduce inequalities in access to healthcare, and 83% disagreed with claims that it would reduce bureaucracy in the NHS.
International experts are also agreed that the Bill is unnecessary, and risks worsening the NHS: several recent reports have emphasised that the NHS is already among the very best and most improved in the world, while the influential Organisation for Economic Cooperation and Development has warned that the Bill could set back progress.
All the while the other prong of the Lansley-Cameron attack on the NHS - wholesale cuts and privatisation - is creating a tsunami of problems, jeopardising the future of health services in localities up and down the country.
Health Service Journal leaks from another suppressed document - a McKinsey report on reconfiguring health services in London ("Safe and Financially Effective") - apparently reveal that only two of the capital's non Foundation Trusts (the Royal Free north of the river, and St George's to the south) are likely to survive the coming financial squeeze. In north east London King George's Hospital has become the latest victim of broken Tory promises to defend district general hospitals.
Even while the hearing into the disastrous failures in Mid Staffordshire Hospitals Foundation Trust continue, the same Trust is facing even bigger cuts than the ones that triggered the first crisis, and is closing A&E overnight. Its neighbour, the University Hospital of North Staffordshire also faces massive cuts as it battles to deliver services with 300 fewer beds in a costly new PFI hospital.
There are crises on Teesside, in Berkshire, and in Peterborough where the Foundation Trust also faces a massive £38m deficit and inflated bills for a £289m PFI hospital. In Mid-Essex GPs are being told to make cuts equivalent to £33 per patient.
And while all of these and many more cash-driven cuts are tearing the heart out of local services, the King's Fund, the Royal College of Nursing and others who have bought into the delusion that replacing hospital services "in the community" would be cheaper, ignore the mounting problems of "bed blocking" (delayed discharge) which flow from inadequate services available outside hospital, and argue that MPs and health bosses must be "brave" and close even more hospitals.
Of course not all care outside NHS hospitals is in the community. Government targets set out in the new operating framework call for "patient choice" to be measured by the numbers of patients treated by non-NHS providers, effectively forcing referrals to the private sector.
A chilling new report from private sector analyst William Laing goes further and envisages the shell of most district general hospitals being reduced to "health malls" offering services from a range of private providers, while NHS treatment is shunted out to "community settings" such as cottage hospitals, clinics and patients' own homes.
If you want to keep your NHS public and keep it local, you have to sign the petitions and help to build a campaign to kill off Lansley's Bill, and the cuts and privatisation that are a part of it.
We have six weeks to save the NHS: then the Lords will begin voting. Let's ensure January lifts off with a round of big meetings fighting the Bill.
|
|
|
|
BCM London Health Emergency • London WC1N 3XX • Copyright © 2012 London Health Emergency
|