| Topic: | Polly Toynbee article on NHS Bill from Guardian 2.9.11 | |
| Posted by: | Allison Franklin | |
| Date/Time: | 02/09/11 20:02:00 |
| In two short days next week the government will railroad through the Commons the longest NHS bill in history, with 1,000 new amendments. (That includes debating the abortion clause, wasting precious time to insult grown women with compulsory counselling from faith groups.) The government may hope attention has wandered over the summer. No doubt the bill will pass in the Commons – but some Lib Dems will lay strong amendments, their conference will see heated debate and the fight in the Lords will be championed by Shirley Williams. The Lords may regard the shocking lack of time for Commons scrutiny for a bill not in either party's manifesto as exactly the kind of constitutional occasion when they should step in. Whatever the government claims, privatisation is still there in its new clauses. The chaotic progress of this attempt to dismantle the NHS will be a casebook study in how not to govern: the NHS may yet lose them the next election. David Cameron inherited an unenviable legacy: the world crisis left him deep debts, inevitable cuts and rising youth unemployment that made inner cities combustible. But whatever else he called "broken", one service that flourished was the NHS. Confronted with such serious problems, why take the grave political risk of wrecking what was working so well? The Commonwealth Fund, comparing similar countries, puts the UK top for effectiveness, care and efficiency and for patient confidence, equity and safety; the UK is significantly less expensive than France, Germany and the US. Britain is the only country where those on below-average incomes are no more likely than the better-off to report trouble in paying medical bills or accessing health due to cost. Mortality from cancer and heart disease was falling faster than anywhere, while waiting lists were all but abolished. Labour's spending yielded good results, despite bad deals on doctors' pay and PFIs. When David Cameron told the Today programme in January that the NHS was "second rate", he had to apologise sharpish. Yet he embarks on this great disruption, costing £2bn, just when the NHS faces its harshest financial squeeze. Funds are not ring-fenced as promised, hit by extra VAT, national insurance and inflation, plus £500m sliced off for social care. Ageing and new technology – new cancer drugs, mechanical hearts – add extra just to stand still. Waiting times are up, hospitals are declaring deficits and by next year, cash shortages will be critical. So why break it all up now? The only explanation is blind ideology, still there in the revised bill, revealed by the legal opinion commissioned by the activist group 38 Degrees, expounded by Dr Evan Harris, rousing the Lib Dems. Spelt out, here are the key clauses that would change the NHS irrecoverably: • The secretary of state will no longer have a duty to provide a health service to all: that's devolved to an unaccountable National Commissioning Board. Nor will he have power to instruct the NCB, only a duty to respect its autonomy: no one can appeal to him against bad decisions. • Local GP commissioners, renamed Clinical Care Groups (CCGs), must put a duty to ensure choice (competition) well above "having regard to" equality. They can be challenged by private companies that want to tender, opening the whole system up to EU competition law, so all the NHS is up for privatisation. • The bill allows wholesale outsourcing of commissioning to the likes of KPMG or United Healthcare if CCGs prefer not to do it: will these prefer the private sector? • The National Commissioning Board has no obligation to distribute funds fairly according to an agreed formula. With no democratic input, it can distribute funds as it likes. Already money is gradually being shifted from north to south: the postcode lottery will grow. • Hospitals have no cap on private beds. When financially squeezed, priority can go to paying off debts with foreign patients. This too opens the NHS to EU competition law. • Monitor, the regulator, has barely altered since the row: it now has a duty to prevent anti-competitive behaviour – which is another, possibly stronger, way of saying promote competition. Extraordinarily, this gigantic re-disorganisation is already happening, with the husks of PCTs already handing over without waiting for the act. So badly construed is this law that some of it will surely never happen. Politically hospitals will not be allowed to go bankrupt, as this envisages. (Research to be published shortly shows that hospital mergers neither save money nor improve quality.) Whatever the bill claims, of course, the health secretary, Andrew Lansley, will still have bedpans tipped over him in the Commons when the NHS erupts. People already protest against any hospital closure: imagine their wrath at finding local beds blocked with private patients to cover costs, or hospitals closed by liquidators. With every NHS organisation vehemently opposed, where's the political profit? The only explanation is that the very existence of an exceptionally successful nationalised health service is such an affront to everything Conservatives believe in that it's worth the political risk of demolishing it once and for all. Let's get one thing straight. The NHS does need constant reform – always has and always will. Megalomaniac politicians of all parties love mighty structural upheaval, but what works is detailed, expert and quite dull. Health economist Prof Alan Maynard, observer of many pointless upheavals, has made the case for evidence-driven medicine for decades. Money is saved and health improved by obliging all to follow best treatment guidelines. The Isle of White saved A&E admissions by sending nurses to teach asthmatics to use their inhalers correctly, so why not everywhere? Nurses can do 70% of what GPs can do, cheaper and, he says, often better because they do follow guidelines. And why have GPs just escaped scrutiny of their performance, by refusing to hand over their data? Prof Ara Darzi's research shows re-admissions after bowel cancer operations vary wildly: heart treatment was improved by eliminating the worst practice outliers. Nursing patients kindly sends approval rates soaring. Forcing all the NHS to follow Nice guidelines doesn't need markets or politically inspired reorganisations. Money coupled with tough targets worked well for Labour, though it too squandered much on vainglorious "new" systems. Let's hope the Lords arrest the damage done by this one. |