Protesters demonstrate against the Health and Social Care Bill. (Photo: Getty)
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A new Bill plots the way back for the NHS - but it's not Labour who are behind it

Caroline Lucas and Andrew George, a Liberal Democrat rebel, are working together on a bill that could be a roadmap for the NHS.

Later today, in the dusk of this parliament, a new Bill will get its first and perhaps only reading in the Commons. It’s unlikely to set pulses racing in any of the main party machines, but in certain circles the NHS Bill represents the last ditch to save a dying public service.

It is the result of three years of patient work led by two leading public health experts, Professor Allyson Pollock and Peter Roderick of the Centre for Primary Care and Public Health at Queen Mary, University of London.

In the bill, they say, lies a trail of breadcrumbs to take us back to a different era. A time before the Health and Social Care Act; before the NHS was such fertile ground for profiteers. A time when money allocated for patient care wasn’t routinely squandered on futile bidding wars, failed private experiments, a contrived internal market and debilitating PFI repayments.

“We’ve been working on this ever since the Health and Social Care Act came in,” says Allyson Pollock, speaking to me earlier this week. “We knew this time would come. What we’ve got in the Health and Social Care Act is a destructive reorganisation which has started the breakup of the NHS.

“If we don’t bring in legislation then privatisation and the breakup of the service will continue; by 2020 the NHS will be unrecognisable”.

Andy Burnham has said in no uncertain terms that a Labour government would repeal the Health and Social Care Act, and end the “Tory market experiment in the NHS”. Strong words, and a welcome departure from the New Labour days when much of the damage was done.

But this isn’t a Labour Bill. The political will has come from the Green Party’s only MP, Caroline Lucas, and a Liberal Democrat, Andrew George. It's backed by rebels from across the benches, PPCs, medical professionals and campaign groups throughout England.

Why do this now, with such a solemn pledge from Labour firmly and repeatedly on record? “They have said they would repeal the act”, says Pollock, “but they haven’t said what they would replace it with and how they would go about reinstating the principles of the NHS”.

If Labour wins enough power to repeal the Health and Social Care Act, and stays true to its word, it will be a tremendous victory. But with contracts in place and business plans cooked up, there will be plenty of clearing up to do even from the two years since the Act came into effect. Arguably, too much than simply canning it can possibly manage.

“We’ve already come too far down this road,” says Caroline Lucas, speaking to me yesterday. “We want to roll back 25 years, look at the whole programme of marketisation that New Labour brought in right up until what’s happening now”.

In its own words, the Bill proposes to “fully restore the NHS as an accountable public service by reversing 25 years of marketisation in the NHS, by abolishing the purchaser-provider split, ending contracting and re-establishing public bodies and public services accountable to local communities”.

How will this be done? With what now seem like very radical ideas behind them, some of the key objectives are:

  • To “reinstate the government’s duty to provide the key NHS services throughout England, including hospitals, medical and nursing services, primary care, mental health and community services”;
  • “abolish the NHS Commissioning Board (NHS England) and re-establish it as a Special Health Authority with regional committees”;
  • “abolish Monitor and repeal the competition and core marketisation provisions of the 2012 Act”;
  • “prohibit ratification of the Transatlantic Trade and Investment Partnership and other international treaties without the approval of Parliament and the devolved legislatures if they would cover the NHS”;
  • centralise NHS debts under the Private Finance Initiative in the Treasury, and require the Treasury to report to Parliament on reducing them;

Given the timing, it’s less clear what can be achieved in the coming weeks - indeed it has attracted its critics for this reason. But as Lucas tells me: “This is about setting an agenda for the election, and for the next parliament. I don’t think it should be about just choosing between the Efford Bill and the status quo. We need something more robust”.

If Labour is serious about ending the Tory market experiment, the party should take note of today’s proceedings. In an emerging corporate climate, the NHS Bill is a refreshing reiteration of the founding principles of a health service being systematically altered, and a blueprint for restoring them, laid down in black-and-white, waiting for anyone with the will to pick them up.

 

Benedict Cooper is a freelance journalist who covers medical politics and the NHS. He tweets @Ben_JS_Cooper.

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A swimming pool and a bleeding toe put my medical competency in doubt

Doctors are used to contending with Google. Sometimes the search engine wins. 

The brutal heatwave affecting southern Europe this summer has become known among locals as “Lucifer”. Having just returned from Italy, I fully understand the nickname. An early excursion caused the beginnings of sunstroke, so we abandoned plans to explore the cultural heritage of the Amalfi region and strayed no further than five metres from the hotel pool for the rest of the week.

The children were delighted, particularly my 12-year-old stepdaughter, Gracie, who proceeded to spend hours at a time playing in the water. Towelling herself after one long session, she noticed something odd.

“What’s happened there?” she asked, holding her foot aloft in front of my face.

I inspected the proffered appendage: on the underside of her big toe was an oblong area of glistening red flesh that looked like a chunk of raw steak.

“Did you injure it?”

She shook her head. “It doesn’t hurt at all.”

I shrugged and said she must have grazed it. She wasn’t convinced, pointing out that she would remember if she had done that. She has great faith in plasters, though, and once it was dressed she forgot all about it. I dismissed it, too, assuming it was one of those things.

By the end of the next day, the pulp on the underside of all of her toes looked the same. As the doctor in the family, I felt under some pressure to come up with an explanation. I made up something about burns from the hot paving slabs around the pool. Gracie didn’t say as much, but her look suggested a dawning scepticism over my claims to hold a medical degree.

The next day, Gracie and her new-found holiday playmate, Eve, abruptly terminated a marathon piggy-in-the-middle session in the pool with Eve’s dad. “Our feet are bleeding,” they announced, somewhat incredulously. Sure enough, bright-red blood was flowing, apparently painlessly, from the bottoms of their big toes.

Doctors are used to contending with Google. Often, what patients discover on the internet causes them undue alarm, and our role is to provide context and reassurance. But not infrequently, people come across information that outstrips our knowledge. On my return from our room with fresh supplies of plasters, my wife looked up from her sun lounger with an air of quiet amusement.

“It’s called ‘pool toe’,” she said, handing me her iPhone. The page she had tracked down described the girls’ situation exactly: friction burns, most commonly seen in children, caused by repetitive hopping about on the abrasive floors of swimming pools. Doctors practising in hot countries must see it all the time. I doubt it presents often to British GPs.

I remained puzzled about the lack of pain. The injuries looked bad, but neither Gracie nor Eve was particularly bothered. Here the internet drew a blank, but I suspect it has to do with the “pruning” of our skin that we’re all familiar with after a soak in the bath. This only occurs over the pulps of our fingers and toes. It was once thought to be caused by water diffusing into skin cells, making them swell, but the truth is far more fascinating.

The wrinkling is an active process, triggered by immersion, in which the blood supply to the pulp regions is switched off, causing the skin there to shrink and pucker. This creates the biological equivalent of tyre treads on our fingers and toes and markedly improves our grip – of great evolutionary advantage when grasping slippery fish in a river, or if trying to maintain balance on slick wet rocks.

The flip side of this is much greater friction, leading to abrasion of the skin through repeated micro-trauma. And the lack of blood flow causes nerves to shut down, depriving us of the pain that would otherwise alert us to the ongoing tissue damage. An adaptation that helped our ancestors hunt in rivers proves considerably less use on a modern summer holiday.

I may not have seen much of the local heritage, but the trip to Italy taught me something new all the same. 

This article first appeared in the 17 August 2017 issue of the New Statesman, Trump goes nuclear