Well, on a broad level, it looks like a way of introducing market forces into the NHS, when there remain serious questions as to the effectiveness of ‘market forces’ in regulating and developing health care provision patients. Beresford : 2005
I think pretty much everyone can agree that we want to see our healthcare system be as efficient as possible, but opinions differ over how to achieve this. I would say the devil is in the detail – but Cameron and Lansley have set out little in the way of supporting detail for their bill.
Most people in this country are rational beings who are capable of examining a proposal and supporting it or not on the basis of available evidence (now there’s one of MY totally unsubstantiated beliefs) – but the evidence in this case seems to have gone missing.
So if the Prime Minister and his Health Secretary believe the Bill is doing the right thing, what do other people, perhaps ones experienced in this field, think?
The world’s leading medical journal, the Lancet argues that the current Bill “spells the end of the NHS”.
The British Medical Association has put out a briefing which takes a measured look at the Bill, and concludes that “the Bill as it currently stands poses an unacceptably high risk to the NHS in England, threatening its ability to operate effectively and equitably. Government health and social care policy, implemented both through and beyond the Bill, will make it harder – not easier – to create the seamless, efficient care that everyone agrees is key to future sustainability.” They call for it to be withdrawn or amended.
The Royal College of Nurses has already had some inputs into changes to the bill, but are looking for more as they have “serious concerns about the Health and Social Care Bill and the reforms that accompany it. We are one of the leading organisations lobbying the Government to change the legislation to reflect the concerns of our members and their patients.”
An open letter to the House of Lords, signed by over 400 experts including 40 Directors of Medicine, was published in The Telegraph arguing that ‘The bill will do irreparable harm to the NHS, to individual patients and to society as a whole’. The same letter continued:
“The Government claims that the reforms have the backing of the health professions. They do not. Neither do they have the public’s support. The Health and Social Care Bill will erode the NHS’s ethical and cooperative foundations and will not deliver efficiency, quality, fairness or choice. We ask the House of Lords to reject passage of the Health and Social Care Bill.”
(For some reason Cameron took this as a show of support. Which surely says something about the reaction he is used to getting by now)
But these groups are all medical. They probably have some vested interest in wanting to cure people or something. What if that’s getting in the way of what the patients want?
Professor Appleby’s research for The Kings Fund finds that more members of the British public than ever believe that the NHS is doing a good job and are satisfied with their service provision
In contrast, waiting times have risen across the country, and in all areas of healthcare provision, over the last 14 months. This follows the implementation of sub-legislative policy reforms and budgetary cuts (data published; Department of Health ‘Time Series’: 2011).
But what if the medics and the patients are both wrong?
A review by Millar et al – Liberating the NHS: Orders of Change? – looks at proposed changes within the NHS: both what they are and how they could be described, and then carries out a literature review of comparable changes elsewhere. Obviously the NHS is unique, but it doesn’t look good. They suggest that the scale of these reforms and their long term effects on the health care service constitute a radical break from previous policies and developments which have not yet been either justified or fully understood in their potential long term effects, and find that the increased focus on price and service competition has no conclusive evidence to suggest that it will necessarily translate into increased quality of care for all patients.
When the group 38 Degrees wanted to put together a legal briefing on the proposed Bill they raised £38, 000 in ONE WEEK and the subsequent briefing raises questions about the statutory provision of care and appropriate overview, accountability and transparency under the reforms being proposed.
These concerns were laid out in a letter to every member of the Lords. You’ll be glad to hear that many of them responded quickly. The winner has to be Lady Richardson, who responded within an hour (from her Blackberry), stating she shared the concerns and would represent them.
If you would like to contact a Lord yourself, 38 degress have a nifty tool you can use to do so.
We’ll be watching on Wednesday.
If you want to write your own letter to a Lord whilst there's still time here are some useful resources-
38Degrees Legal Briefing available here
British Medical Association briefing available here
Royal College of Nurses briefing, available here
UK Uncut press release, available here
Squeamish Louise who informs us, "The vast majority of research was done by Glen Noble, who apparently found it a relaxing alternative to his PhD."