Health and Social Care Bill

Memorandum submitted by David H Smith (HS 106)


This is a personal submission based mainly on my wife’s experience of US and UK healthcare. I have written it because for her to have to repeat her experience yet again to yourselves would be too distressing.

This story illustrates how commercial organisations simply cannot be trusted with healthcare commissioning.


My wife's experience includes:


a. the circumstances leading to the death of her daughter in the US, and the contrast with the excellent subsequent treatment of her son in the NHS.


b. Her experience of working in healthcare in Portland Maine, USA and in England.


Christian names have been changed.



1. My wife had two children, John and Janet, by her first husband, both of whom turned out to have the hereditary disease cystic fibrosis. This disease is characterised by the inability of the body to manufacture certain enzymes in sufficient quantity. These enzymes fall into two classes, digestive enzymes and enzymes that breakup the mucus in the lungs.


2. For some years neither child was correctly diagnosed. The elder, John had some digestive problems but these were put down to other causes. This is why they did not refrain from having another child.


3. For many years the daughter Janet had no symptoms. The local hospital asked if she would go in for tests to discover why she was so healthy. Initially my wife refused because she feared hospital acquired infections. Eventually she gave way and Janet acquired B Cepacia in hospital. Her lung function rapidly deteriorated and she was told that the only hope was a lung transplant. They had the best available health insurance but that did not of course cover such an operation. They had to appeal on TV for funds. Having got the funds – Janet was very popular, they applied to the hospital who told them that, no, they could not do the operation because the outlook was not good for patients with superbugs. This decision was not of course based on a rational use of scarce resources, because they had the money. It was simply that the statistics would not look good if Janet did not survive. My wife and her then husband had neither the time nor the resources to take the hospital to court. Janet died. The marriage broke up.


4. Before the question of transplant arose, however, Janet had had frequent periods in hospital. In each case the insurance company wanted to halve the number of days in hospital that the doctor felt was required. Doctors had to spend far more time on the paperwork than on treating the patient, and of course the HMO would also be spending money on this bureaucracy. This is why US healthcare is so expensive.


5. We are convinced that if healthcare commissioning is left to large commercial businesses here, they will adopt identical attitudes. Access to publicly funded healthcare will be massively restricted.


In this way the principle that the government claims it wishes to preserve, namely comprehensive care publicly funded and free at the point of use, will have been abandoned, the benefactors being large multinational HMOs and lawyers.


6. John's experience in England under the NHS could not have been more different. For many years, he too had avoided respiratory problems. When they developed he was initially cared for at the local hospital. He needed frequent courses of intra venous antibiotics, which we were trained to administer. In due course he was referred to Harefield, where he received a successful double lung transplant in spite of having been infected by two superbugs. He has since taken a degree in law and is now studying for a PhD.


7. The second aspect of my wife’s experience covers her work in a gastro-enterology clinic in Portland Maine. Initially the clinic was a happy ship. Everyone cared for the patients, all the doctors lived well with houses in the posh district, boats etc. But then one partner insisted on bringing in a management consultant, who showed the partners how they could become really wealthy. Turnover increased dramatically but the standard of care dropped equally dramatically, patients being sent home far too early. All the best nurses resigned. This shows how easily money can corrupt doctors.


8. Having moved back to England, the land of her birth, my wife took a job at the local hospital in Dorchester. Part of her work was scheduling in patients who had been turned out of private hospitals too early, or after botched treatment. Once again we see the private sector making profits not out of efficient operation, but by externalising their costs. The legal duty of company directors is to make as much money as possible for shareholders, regardless of the interests of customers or anyone else. It is left up to government to try to restrain their worst excesses, and frankly in a complex area like healthcare, it is just too difficult and expensive a job. The private sector has the luxury of the better lawyers.


9. We can see no problem with GPs commissioning care so long as they feel they can manage this without contracting with a large commercial company. GPs are admittedly self employed but mercifully they still think about the good of their patients. There are surely other models for providing the support GPs need. Why can they not  get together and form a co-operative?


As I understand it, the killer part of the Bill is the imposition of competition with formal tendering procedures. Whereas in theory quality can be taken into account as well as price, it is just too difficult to define quality in such a way as to hold these companies to account – to make them behave like reasonable human beings, which of course they are not. If GPs do not feel able to handle commissioning themselves, how can they be expected to cope with HMOs lawyers in negotiating contracts?


10. I have told the story of one family in the USA. It is repeated however throughout the Union. Families with the best insurance are bankrupted if a member has a long illness. Unless members of the committee have examined the evidence from the USA, I submit that they cannot form any reasonable judgement about whether the measures proposed in this Bill can work.

11. My own experience was primarily in the Energy sector and I was deeply involved in the liberalisation of the gas industry. Whereas it will remain a matter of debate as to whether the liberalisation was in the public interest, what is incontestable is the huge and continuing efforts of lawyers, consultants, business analysts, engineers and accountants in managing the relationships between the various players in the gas supply sector. This sector is simple compared with healthcare. How much more effort will be wasted if this reform goes through?

March 2011