Leader: Mr Cameron, these NHS reforms are a mess that no one can defend

Cameron says that this is not the "privatisation" of the health service. There is no better word.

By Staff blogger Published 10 November 2011

Dear Prime Minister,

You once said that your political priorities could be summed up in three letters: NHS. In last year's election campaign, you signalled your commitment to the health service with two promises. First, there would be no "top-down reorganisations". Second, its budget would rise every year. You must now realise that those pledges cannot be met.

The claim that NHS funds would be "ring-fenced" was always tenuous. The imposition of £20bn of "efficiency savings" on the health department guarantees that front-line services will have fewer resources. No one denies that there is waste in the system but no modern health service has ever implemented the kind of austerity drive you demand, let alone in such a short period. You might not call it "cutting" but that is how it feels. Inflation will stretch budgets further. "Real-terms" spending increases are a fantasy.

As the NHS struggles to cope with this harsh economic climate, you also want it to implement the biggest organisational change in its history -
a reform that rips up established structures for managing resources and fundamentally changes the service's founding ethos. You must realise that this is a huge error.

The Health and Social Care Bill was originally styled as a liberalising reform. The theory, developed by your Health Secretary, Andrew Lansley, is that family doctors should buy care on behalf of their patients, shopping in a marketplace in which private providers compete with state care. Primary care trusts (PCTs), which currently manage a limited "internal market" process, would be scrapped.

There is a case for reforming NHS commissioning, with more GP involvement, and for slimming down PCTs. That could have been done without legislation. The real purpose of this reform is to transform the NHS from a system where care is mostly provided by the state to one where it is largely provided by private companies. You say that this is not the “privatisation" of the health service. There is no better word.

Perhaps you can make the case for such a reform and persuade people to go along with it but you have not done so. Instead, you and Mr Lansley have hidden behind long-term budget pressures. Since NHS costs rise inexorably, the argument goes, the private sector must plug the gap. It is true that the 1940s model of monolithic, centralised state care was unresponsive to patients' needs and disinclined to innovate. It is also true that partnership with the private sector can be an effective spur to change. The kind of free-for-all that Mr Lansley envisages would not share best practice or increase efficiency, however. It would sow mistrust and confusion. It would undermine the collaborative process that is vital for the treatment of chronic conditions. It would turn ill-health into a commodity, with some problems more lucrative to solve than others. Cataract operations might thrive in the free market; long-term treatment of mental health disorders would be forgotten.

The vision is flawed. Meanwhile, the bill has been mangled by amendments. The essence of Mr Lansley's plan survives but with ad hoc layers of bureaucratic complexity thrown in by anxious Lib Dems. It is a mess that no one loves and no one can sincerely defend. There is no advantage to you in proceeding with this fiasco. The only reason for doing so would be stubbornness and fear of derision for exercising such a U-turn. The cost of that pride would be paid by every person in Britain who relies on the NHS. Eventually, it would be paid also in lost votes for the Conservative Party. You have shown in the past that you can be flexible, abandoning policies that are unpopular or plain bad. This one is both. You claim to love the NHS. We implore you, then, to think again.

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Tags: NHS

3 comments

Sat, 2011-11-12 09:54 — Dr Kailash Chand OBE (not verified)

Brilliant article,articulating the views of millions .But,unfortunately this will fall on deaf ears.David Cameron “child of Thatcher” in Downing Street intends to achieve what eluded all the other Tory Governments since Bevin created the country’s most cherished institution in 1948.Winston Churchill lost the battle to kill the NHS at birth. Thatcher was prevented by cooler heads from creating an insurance-based system. Cameron, unless stopped in his tracks, will privatise the service.What we will have is- instead of GP led primary care and consultant led hospital services, we will witness “any willing provider” – wolfs in sheep's clothes– cherry pick the most lucrative operations and the NHS will be left to provide complex, expensive care.

Monitor, will unleash a free market tsunami which is bound to end with long waiting times, treatments rationed and topup,co-payment charges introduced.Health secretary no longer having the responsibility to provide universal health care.

The Health & Social care bill before you will destroy the NHS as we know it .The NHS will turn into the medical equivalent of a flawed, privatised rail network.This would be the sickest reform proposed by Andrew Lansley.

Thatcher was wrong in introducing the poll tax. John Major could not survive Black Wednesday. Iraq was the waterloo of Blair . Brown was a poor choice of Blair replacement.Dismantling the NHS will be engraved on Cameron’s political gravestone.Lords, please don't allow the NHS to be destroyed.

Fri, 2011-11-11 16:36 — JacquesOuze

You could add that there's very little support for these reforms amongst the million and a half people that work for the NHS. In fact the government spent a good deal of time and effort in pissing off the very people they expected to implement the reforms by branding them as useless bureacrats, public sector fat cats or people with undeserved gold-plated pensions. Way to go Mr Lansley

Sat, 2011-11-12 16:34 — SaltleyGates (not verified)

Who provided the foundations, and Foundation Trusts, and plans for the Conservatives final destruction of the Public NHS?

The Labour Party from 2000-date

Messrs Milburn, Reid,Hewitt Johnson and Burnham with support of Blair and Brown and the gutless Labour Party members who sat back and allowed all of it.

From Labours pathetic response to the break up and privatisation of the NHS to Andy (developer of plans to Privatise NHS Hitchingbrooke) Burnham being placed at Health, an insult to Health Workers.Both are sure signs that Labour will not fight the Bill and will not reverse the Privatisations and break up of the NHS.

There are I think Ten reasons not to trust Burnham or the Labour Party with the NHS

1. Labours Foundation Trusts, introduced without Manifesto Commitment by NHS Privatisation Consultant Labour Minister Mr Alan Milburn . FTs paved the way for the break up of the NHS into competitive units that could then be privatised. Labour could have secured the NHS and its core principles instead Labour Marketised, encouraged wasteful competition and an aggressive managerial culture.

2, Labours PFI led to a massive redistribution of wealth from the public sector to Labours Corporate Private Sector pals.

3. Labour re-introduced the Conservatives Internal Market, leading to more fracturing of NHS services, more competition, more waste and more bureacracy.

4. Labours NHS Privatisation Labour directly privatised NHS Logistics and other important NHS Services , again redistributing profits to Labours wealthy Corporate backers.

5. Labour destroyed real regulation by closing down Community Health Councils and producing a number of Light Touch Regulators. This led to the farce of MONITOR giving MIDSTAFFS FT Three Stars shortly before the massive scandal of the manaements bullying regime broke.

6. Labour Ex Ministers,MPs and Peers have acted as Consultants, pimps and procurers for Private Sector interests seeking to take over parts of the NHS. Labour Minister Patricia Hewitt was caught adverising NHS Community Services to the highest bidder in the European Journal.

7. Labour fatuous NHS Constitution; the biggest load of bullshit since Browns Golden Age of Finance Speech to the Banksters; full of spin, hot air, glossy pictures, wishes and promises but signifying absoloutely nothing. Just another insult to the intelligence of NHS Workers and Service Users.

8. Labour broke up the NHS internal Cooperation and Planning that was the centre of NHS.

9. Labour attacked NHS Staff , increasing Temporary contracts, attacking pension rights, destroying job security and outsourcing many jobs to Temp or Agency status. Labours whole drive in power was to undermine the solidarity and power of organised Health Workers.

10. Labour could have stregnthened the core NHS values of Sharing, Co-operation, Solidarity, Planning, Democracy, Equality, Workers Self Management, Regulation and Governance.Instead they cast these values aside for the cruel cash nexus of the Market, Competition, Bottom Line, Privatisation and Inequality, Hierachy and Bullying Anti Union Management.

Mr Burnham is a disasterous choice as shadow secretary of Health, he is a right wing, Neo Liberal, New Labour, Blairite. Indeed under Mr Burnham Labour lost the confidece of hundreds of thousands of NHS Workers who refused to vote for such a Right Wing, Privatising NHS Ministers, one major reason Labour lost the election.

Mr Burnham lets not forget trumpets his championing GP Commissioning the very mechanism used by the ConDems to break the NHS. He also accepts Privatisation,FT,PFI,Internal Markets and Inequlaity of Health .

Labours response to the Condems NHS Bill has been spineless and pathetic. How many Leaflets, Meetings,Pamphlets, Demonstrations has the Labour Party organised against this Bill?

The Bill has been opposed not by right wing privatisers in Labour but by Trade Unionists, Students,Patients,Community and Health Workers

Health Workers know Labour and ConDems are in agreement over the break up of the NHS and the Privatisation and Marketisation of as much of it as the Private Sector can make pay. The Charities are skulking about like Vultures waiting for the remainder.

Labour is not trusted by Health Workers

Only Direct Action will Save our NHS

Labour is incapable of fighting for the NHS Mr Burnhams appointment underlines that there will be no fight for the NHS by Labour

In Power Labour sold out our NHS in Opposition they sit back and watch or make money from its destruction

Labour sold out our NHS Services