Health and Social Care Bill

Memorandum submitted by Ken Kirk, Claire Hughes, David Hughes and Mick Barry (HS 04)

1. Over recent decades we have become one of the most unequal countries in Europe. Despite this, there doesn't appear to a recognition that poorer regions, with a higher proportion of patients in lower socio-economic groups, need more healthcare than patients in more affluent areas. The GP Consortia in poorer areas will be overloaded with conditions such as smoking-related and obesity illnesses, resulting in an impoverished health service, adding further to local people's disadvantage. We occasionally hear of a postcode lottery now for certain health services. But the effect of this Bill will add a huge disparity to the lives of the poor. A founding principle of the NHS, the provision of a comprehensive service for all regardless of social background, will be lost. 

2. The insistence that all health services will be put out to tender, will in some circumstances, put the local hospital out of business. as private providers offer a "loss leader" low price that the local hospitals can't possibly match. The Consortium, under competition rules, will be forced to accept. Once the hospital is gone (or perhaps reduced to offering a rump of the unprofitable services) the private provider can then look to make its profit. In effect, England's public health service will be closed down by this Bill.

3. As "efficiency savings" bite, so GP Consortia will become rationing organisations, that will exclude more and more health procedures. Patients will then definitely have a 'choice' - going private or going without.

4. The Bill provides for scant public involvement in the provision of local health services. GP consortia and the Commissioning Board will take their decisions in secret, and are not even obliged to go through the motions of consultation. Local people will only be provided with PR spin. There is no statutory right to know what is being discussed, to provide hard information or to explain the financial situation to local communities. Council "Health and Wellbeing" committees will only offer token public involvement, and the "Local Healthwatch" bodies set up by the Bill will be ineffective advice and information bodies only, with limited local independence.

5. All limits on the money Foundation Trusts can earn from private medicine are to be scrapped. But with NHS budgets frozen for four years, and £20bn of ’efficiency savings’ forcing down the price hospitals are paid by the NHS for each item of treatment, this will more or less compel many hospital managers to prioritise attracting wealthy private patients from both home or abroad – rather than providing services for less profitable NHS-funded.

6.  England's primary care system is the best in the world. There is a real danger that the trusted nature of the primary care patient-doctor relationship will be undermined by this Bill, as GPs add a rationing function to their job specification. For example, on the one hand the GP might say "I think you need this procedure", but on the other he/she may have to say "but we no longer provide it on the NHS, our consortium budget won't allow it."

7. In reality most GPs will not do any of the commissioning themselves. They are not trained and have no time for this role and many are being dragged reluctantly into consortia they don’t support. So the consortia will hand the reins over to managers from private management consultants, Equally, GPs are dedicated health professionals, and could be persuaded, brow-beaten or 'hood-winked' by sophisticated commercial operators, to buy health services that are more in the interests of private profit and not solely in the interests of the health of their populations.

8. Price competition is to be introduced in clinical services despite warnings from all sides (including NHS chief executive Sir David Nicholson) that this will trigger a disastrous race to the bottom, undermining the quality of care in just the same way as competitive tendering of hospital cleaning services wrecked hygiene standards in the 1980s and unleashed a wave of MRSA-style infections.

9. The overwhelming opinion of all professionals in the health industry, be they doctors (BMA, RCGPs), nurses (RCN), the health unions (Unison and the GMB), or patients groups oppose this legislation; even Conservative members of the Commons Health Committee have been critical. Only private health corporations like America's United Health and Care UK, who stand to gain considerably from the contracts when they bid for the most profitable services, are in favour.

February 2011