Writing to my MP again... I know, I really should get a life....!

Alien Castle

England

Earth

The Hon L de Mocrat MP
House of Commons
London
SW1A 0AA

 3 April 2011

Dear Mr de Mocrat,


Thank you for taking the time to write to me again. I also appreciate the inclusion of Lord Howe's response. However, I did not find your response or that of Lord Howe reassuring. If you forgive the analogy, if someone proposes to make holes in a perfectly serviceable boat, then the simultaneous offer of installing pumps to keep the water out will inevitably lead me to suggest that not making the holes is the more sensible option. And this is how I feel about the Health and Social Care Bill. Whilst some of the changes made to the bill are an improvement, fundamentally it is flawed and risks destroying the NHS.
I wish to raise some specific points from Lord‟s Howe‟s letter.

• 1. Lord Howe states in his second paragraph that England‟s healthcare outcomes lag behind other countries.

As, I have said previously, this analysis is very simplistic and dangerously misleading. I would encourage you to read the British Medical Journal article I mentioned to you before (if you haven't already) by John Appleby of the Kings Fund. [Appleby, J. Does poor health justify NHS reform? BMJ (2011) 342:d566]. The article is freely available to all on the BMJ website. As Professor Appleby explains, point comparisons of healthcare outcomes do not tell anything like the whole story. To quote from the article;

“Not only has the UK had the largest fall in death rates from myocardial infarction between 1980 and 2006 of any European country, if trends over the past 30 years continue, it will have a lower death rate than France as soon as 2012”

Despite the fact that until recently the UK spent less on healthcare than comparable countries will have seen the fastest improving outcomes in both heart disease and cancer. I fully accept that healthcare outcome statistics are not straight-forward and it is very common for them to be misunderstood – often in the media. However surely, those responsible for healthcare should have a much better understanding of the data, otherwise it is impossible to formulate any kind of workable policy

• 2. In that same paragraph, the minister describes falling productivity in the NHS (presumably, based on the Office for National Statistics data.)

These data demonstrate a fall based on a simple comparison of input of funds compared to output – measured in terms of  'activity.' The problem is that this is meaningless without some concept of quality of care. The report itself says:

“The measurement of quality needs further development to become comprehensive and relevant. We may be underestimating quality improvement.” 

The University of York's report on NHS productivity that I referred to before is a far more comprehensive study [University of York Centre for Health Economics] There is a need to always look to maximise productivity, although this is far from straight-forward to actually measure. Healthcare is not like a factory, outcomes must be very carefully defined.

It is very difficult for me to take seriously anything that Lord Howe says, after he begins his response with two statements that I know to be inaccurate. Why should I trust any of the reassurances that he gives?

• 3. It concerns me greatly that the minister responsible for this cannot tell whether the bill opens up the NHS to EU competition law or not.

This is clearly of fundamental importance and whether it is an intended consequence or not, surely this should be known before the House votes on the bill.

• 4. The use of competition to drive up standards is something that all three political parties broadly support.

However, there is nothing in this bill that prevents independent providers from 'cherry-picking'profitable services. Furthermore, according to the White Paper from 2010, there will be something around a 14% weighting towards private sector providers compared with NHS trusts due to the supposed financial advantages NHS organisations have. Whilst I am not necessarily against all competition per se (I would like to see hear more debate) as things stand, it is a system that will be significantly biased towards non-NHS providers. NHS trusts rely on cross-subsidising to cover the costs of services that cannot make a surplus and to cover the costs of training (estimated at around £5Bn/year for the NHS).

• 5. The argument for increased efficiency is at best confused.

As I have described to you previously, major hospital trusts will have to go from having contracts with a small number of PCTs to having contracts with multiple GP consortia. This will inevitably multiply the work and administrative costs. In order to ensure quality for a multitude of suppliers and to commission more complex treatment whole new layers of bureaucracy are being created such as the Care Quality Commission, Lord Howe referred to. It remains to be seen whether these changes will actually save any money at all.

• 6. The government claims that the number of GPs that have signed up to become 'pathfinders' demonstrates broad support for their plans.

This is plainly untrue. There are two more significant reasons why GPs have signed up. Firstly, they have a deep commitment to their professional responsibility and know that providing the best care for their patients necessitates being involved in shaping the plans. Involvement is not the same thing as enthusiasm. Furthermore, the way the DOH has structured things, any consortia formed before April this year will not be responsible for PCT debts. Any formed later will have to carry that burden.

I am not by nature cynical about any politician, however there is indeed significant dishonesty on the part of the government in response to questions about the NHS. On 8th February, in Prime Minsters Question Time, David Cameron was asked whether the NHS was safe in the Government's hands. Mr Cameron replied:

On the NHS, I can do no better than quote the shadow Secretary of State for Health. This is what he said about our plans:

 "No-one in the House of Commons knows more about the NHS than Andrew Lansley... Andrew Lansley spent six years in Opposition as shadow health secretary. No-one has visited more of the NHS. No-one has talked to more people who work in the NHS than Andrew Lansley... these plans are consistent, coherent and comprehensive. I would expect nothing less from Andrew Lansley."

That was said by Labour's shadow Health Secretary. I could not have put it better myself.[Hansard 9 Feb 2011 : Column 299]

This is what John Healey actually said (I think the missing words are quite important):

“This is a Conservative plan for the NHS. This is Andrew Lansley's plan. No-one in the House of Commons knows more about the NHS than Andrew Lansley – except perhaps Stephen Dorrell. But Andrew Lansley spent six years in Opposition as shadow health secretary. No-one has visited more of the NHS. No-one has talked to more people who work in the NHS than Andrew Lansley. 

The Health select committee concludes – in so many words – and as I believe, that these are the wrong reforms at the wrong time, “blunting the ability of the NHS to respond to the Nicholson challenge” to improve services to patients and make sound efficiencies on a scale the NHS has never achieved before.

But these plans are consistent, coherent and comprehensive. I would expect nothing less from Andrew Lansley.

[John Healey's Speach to the King's Fund only the words in bold were read out by the Prime Minister.]

One could describe the Prime Minister's response as in-keeping with theatre-poster writers who excel at quoting critics out of context. However, like the references to healthcare outcomes in other countries it is entirely misleading. I am not trying to make a party-political point here, simply to emphasise that the arguments in favour of this bill are a mixture of flawed logic and misleading information. I work in the NHS, I am aware of its weaknesses and issues. However, I also know of its great strengths which are hugely threatened by this bill.

I thank you again for inviting me to your constituency surgery; I will find one that I can attend, in order to discuss this with you further.

Yours sincerely







Dr alienfromzog BSc(Hons) MBChB MRCS(Ed) DCH