Health and Social Care Bill

Memorandum submitted by Keep Our NHS Public (HSR 52)

Keep Our NHS Public ( was formed in 2005 when three organizations, the National Health Service Consultants Association, the National Health Service Support Federation and Health Emergency came together in 2005 to form an organization to fight the creeping privatization of the NHS. This accellerated after the NHS Plan of 2000 and the formation of the Commercial Directorate in the Department of Health in 2003. We have 30 branches around the country (four formed this year), and our members are ordinary citizens concerned about the NHS, some of whom are health professionals. We are non party-political.

We consider that the Health and Social Care Bill should be withdrawn as it is badly drafted, has no democratic mandate and makes such fundamental changes to the NHS that it requires a referendum to give it legitimacy.

Mr Lansley’s aims of putting patients at the heart of care, putting clinicians in charge of commissioning and reducing bureaucracy can be achieved without legislation, which prompts the question - what is the purpose of this Bill? We conclude that behind the reassuring language is a hidden agenda to turn the NHS into a fully fledged market. Despite the reassurance of politicians the changes proposed, whilst rectifying some of the deficiencies in the original Bill are not fundamentally altering the proposed architecture of the NHS, merely adding further complexity.

The changes made after the listening exercise and the government’s response to the Future Forum’s report have generated another 180 amendments but have not changed the ultimate aim of this Bill which is to turn the NHS into a fully fledged market funded by the taxpayer and using the NHS logo. They have added to the complexity of an already complex bill (described by Lord David Owen, a former Health Minister, as a bill of ‘staggering ineptitude’). They have increased, rather than reduced, bureaucracy with an rise in statutory bodies from almost 200 to over 500.

We do not want the NHS turned into a market, which has been shown to be an inappropriate model for the provision of health care. This opposition to a market in health care has been endorsed in public meetings throughout the country. We do not want to pursue the US model, which is expensive, inequitable and achieves poorer outcomes for the nation as a whole.

It is constantly reiterated that competition is necessary to achieve efficiencies and innovation yet the evidence for this is lacking and the evidence against using the private sector to drive change is that it increases costs and provides a more inequitable health system in which fraud is more likely to occur.

Although there are some amendments which ameliorate the detrimental effects of this Bill the amendments we would like to see are:

· The Secretary of State should continue to have a duty to provide a comprehensive health service. Delegating this to an unelected quango the National Commissioning Board and unelected GP consortia who may make their own decisions about which services should be provided is wrong. The amendments do not reassure us fully. Why not keep the wording of the 2006 Act- or even the 1946 Act? ‘Act with a view to securing’ is not the same as a responsibility to ‘provide a comprehensive service’.

· The proposed GP consortia now called Clinical Commissioning groups should be:

1. responsible for providing services for a geographical area co-terminous with the local authority

2. include public health doctors and any hospital doctors should come from the local area not outside it. Adding one doctor and two lay people smacks of tokenism.

3. properly consult if changes to services are to be made

4. Be entered into voluntarily by GPs

· No further PCTs or SHAs should be abolished. GPs who do not wish to join in consortia should work closely with PCTs or PCT clusters to plan services.

· PCTs should continue to carry out the other 400 statutory functions for which they are responsible whilst thoughtful measured ways of reducing bureaucracy should be worked out.

· Monitor should be abolished and hospitals regulated by the DH via the SHAs and CQC. The amendments are tinkering with the edges -we do not need a huge economic regulator to run a public service like the NHS

· Health and Wellbeing Boards should be given powers to monitor the proposed clinical commissioning groups. The amendments do not give them powers if they are to be created as statutory bodes they should have powers to affect the proposed clinical commissioning groups.

· The purchaser provider split should be abolished and collaborative working encouraged between primary, secondary and tertiary care

· The NHS should be the preferred provider and should it be necessary to use private or voluntary organizations then there should be no commercial confidentiality. All transactions should be transparent and published for the taxpaying citizens to scrutinize. There should be no commercial confidentiality in contracts using taxpayer’s money.

· We think the business model in which Foundation Trusts must make a profit but are not required to provide all necessary services should be scrapped. Should a business model be retained then any surpluses made by any organization within the NHS must be returned to the NHS locally or centrally for reuse. No bonus payments should be paid to GP consortia or to hospitals achieving targets.

· The cap on private practice income in Foundation Trusts should be retained.

· Any charges which are envisaged in the future must be approved by parliament and not just imposed by the NCB and clinical commissioning groups

· Education and training are not part of this Bill but the subject to another Bill despite being included in the listening exercise. We think it is the height of folly to assume that locally organised training will enable the medical workforce needs of England to be met in the future. The Royal Colleges for years oversaw an excellent training programme, which is recognized throughout the world. The Deanery system, which has evolved over the last decade, was more bureaucratic and relied less on voluntary work by consultants, but achieved good results. Introducing a purchaser/provider split was unnecessary but abolishing the whole system is wrong.

The more one reads these amendments and looks at the chaos in the NHS at present the clearer our position is that the Bill should be scrapped and Mr Lansleys laudable aims achieved through other means. The evidence the Bill Committee has received about the success of stroke and cancer networks in improving care and the need for integration show it is unnecessary to legislate to improve health outcomes. The Department of Health GP witness said that fundholding, GP commissioning and practice based commissioning (PBC) had all failed so why change things to bring in the private sector and GPs as commissioners? In fact PBC has worked in some areas notably Cumbria where PCTS and GPs have been able to work together satisfactorily. However when one discovers that NHS London are spending £7million paying private companies to train GPs in commissioning it suggests that Mr Lansleys faith in his model of care, that GPs are the people to do commissioning, is misplaced.

Scotland and Wales have got rid of the purchaser provider split and the nonsense of World Class Commissioning and their health services are functioning well. In fact the latest figures from Scotland compared with England show the negative effects of the Purchaser/ Provider split and Payment by Results in driving up hospital activity in England with no improvement in results.

This Bill is a mess and we as ordinary citizens whose voice has not been heard, believe the best thing to do is to withdraw the Bill before any more money is wasted on redundancies, and work to improve existing structures in a collaborative way.

July 2011

Prepared 19th July 2011