Health and Social Care Bill

Memorandum submitted by Julie Partridge (HS 124)

I am writing to express my concerns over the White Paper - Liberating the NHS

I am writing in a private capacity because I have a number of concerns regarding the white paper, Liberating the NHS. I am not an expert but I am a patient and a taxpayer and I believe the changes are going to do irreparable harm to the NHS.

My summary is as below:

1) GPs should be allowed to concentrate on upping their game rather than being employed as financial advisors to the NHS

2) There is a conflict between The department for Work and Pensions and The Department of Health where one Dept - the Dept of Work and Pensions does not trust the other Dept – Dept for Health to make a decision on their patients ability to work, but who are strangely going to be trusted to control the NHS budget.

3) The Public Health White Paper was drafted by the food and alcohol industry – conflict of interest leading back to Andrew Lansley

4) There are a significant number of conflicts of interest with regards to private companies profiting from the tax payer which ought to trigger amendments and or judicial reviews in the interest of patients and tax payers.

5) Price Competition, cherry picking and the "level playing field" which is fixed in favour of private health companies where it will cost more to treat patient using private health care providers

6) "You and your GP will decide where you will get treated." – this is an untruth it is not possible unless the consortium of which the GP is a compulsory member has a contract with a particular hospital, the patient will not be able to go there from their GP.

7) I am not a consumer; I am either a patient or a taxpayer, sometimes both but not a consumer. If you want to make me a consumer then there has to be an NI opt out clause. Also, changes are not in the interest of the tax payer who happen to fund the NHS

8) The real government prescription

1) As a patient I have been alarmed to read some of the facts that have been released by both the Conservative Party and The Liberal Democrats to garner support for these reforms. One of them being that 23% of cancer patients are only diagnosed when they turn up at hospital as emergencies. This means that either patients were not registered with a GP or that a significant number of GPs are failing to diagnosis cancer. My brother has lung cancer and he went to his GP many times with persistent chest infections and a cough that he could not shake off. His GP just kept giving him antibiotics. Finally he was sent for an x-ray which revealed a shadow on his lung. He has been informed that his cancer cannot be cured but he is having radiation and chemotherapy to prolong his life. As he is an ex smoker, I would have expected red flags to have been set off and the GP to have sent him immediately for an x-ray where there might have been chance of a cure. I feel my brothers GP let him down.

In like manner it was recently announced that 1 in 4 patients die from rare cancers because GPs fail to diagnose them in time. The Dept of Health were quick to make assurances that GPs will up their game but quite frankly assurances are not good enough. GPs are not financial advisors, and they should concentrate on providing care so that they can up their game, rather than be forced to take over dismantling the NHS on behalf of the Coalition. The reality is that GPs are neither trained nor skilled in planning and providing health services for the whole population; their duty is to care for the patient. They know this, but have no choice now but to allow their practices to join consortium or find themselves taken over by the private sector. But they also know the new consortium will over time be run by shareholders for profit and in time so will all the services.

2) I would like to know why the NHS is being dismantled by the Department of Health in favour of GP commissioning but the Department for Work and Pension rejects their expert opinion? If the white paper goes through (if that is the right phrase) won’t the Department for Work and Pension be mandated by parliament when Atos Healthcare retests everyone on sickness benefits and apply similar tests to those currently claiming Disability Living Allowance, to accept the view of GPs, consultants or other experts with an in depth knowledge of their patient’s condition? It would seem extremely perverse otherwise - the same health professionals who are not trusted to make a decision on their patients ability to work, are strangely going to be trusted to control the NHS budget.

3) I am concerned at the lack of joined up thinking with regard to the public health white paper. Andrew Lansley announced on 13/03/2011 that the NHS will not be able to meet the demands of people with long-term conditions such as diabetes and asthma unless it changes. He says there will be a 252% increase in the number of people over 65 with one or more such conditions by 2050. Lansley says the NHS must work smarter to keep people out of hospital in the first place which also saves money. He is absolutely right - this should be the way forward, it won’t happen though because the planned overhaul of the NHS won’t be transferring power to GPs.

Dr Mark Porter, the chairman of the British Medical Association's hospital consultants committee has already warned that the reforms means the NHS will be a 'tattered safety net' for patients with complex illnesses, such as diabetes and obesity because private healthcare firms will "cherry-pick" patients who are easy to treat". The secretary of state is in effect abolishing his duty to provide and secure comprehensive services for the whole population, while the mechanisms which enabled that to happen would also be repealed. The white paper provides for the abolition of the statutory cornerstone of the NHS (and therefore of the NHS itself), namely, the secretary of state’s duty to provide a universal health system. The new consortium would therefore have no duty to provide and secure comprehensive care as they would no longer have responsibility to all patients and residents in a defined area. Instead, local authorities may end up becoming  providers of last resort when patients are denied or cannot get care. Therefore Lansley can significantly reduce the forecasted numbers of people living with asthma and diabetes into their sixties, let’s hope he sees this as a negative.

My real concern is with the recent announcement that people who live in deprived areas are 2.5 times more likely to die from cardiovascular disease than in wealthiest counterparts. Dept of Health figures show that adult obesity levels vary, with 15% of the population in wealthier parts of London being obese compared with 30% in Stockton on Tees and Hartlepool in Cleveland. Nation wide, only 50% of us eat enough fruit and vegetables. Yet, the Public Health White Paper was drafted by groups dominated by food and alcohol industry members. Lansley’s decision to "improve" public health through voluntary agreements with the food and alcohol industry is like putting Hitler in charge of our immigration policy. We have the fattest children in Europe, where it has been predicted that this will be the first generation to die before their parents. Soft touch policies with regard to corporate responsibility, means that Lansley has abdicated ministerial responsibility and placed corporate interests above our children‘s health and well being. I am constantly surprised that more questions haven’t been raised regarding the link between Lansley being funded by advertising companies that had contracts with companies such as Mars when he was in opposition, and the voluntary agreements that now form public health policy.

4) In my view there are a significant number of conflicts of interest within the white paper.

Andrew Lansley has been forced to give public assurances that GPs would not be allowed to profit from his reforms. The denial followed leaked documents that showed under Lansley’s reforms, GPs could refer patients to private health companies in which they had a financial interest. Documents leaked to the Guardian reveal one private health firm, IHP, in discussion with 3 GP consortiums actually proposed to GPs that he could set up a company that would turn under spends in their annual budget – in effect, savings on patient spending – into profits. This company, which aims to list on the stock market in three to five years, would treat patients at 95% of the cost of the NHS. This putative saving, amounting to £40 per patient, would be booked as earnings.

American Healthcare providers are lining up to make millions if not billons of money directly at the English taxpayers expense, by again, exploiting the loophole where they can form a Consortia and then send their patients to companies where they have a financial interest. Frank Dobson in a parliamentary session asked Andrew Lansley if the American health corporations, who have been indicted in the United States for defrauding US taxpayers, doctors, patients and, sometimes, all three were to be ruled out of any outfits obtaining contracts to run consortia he said "I can’t say". Well if he can’t, who can? Or is it more of a case that he won’t say? Andrew Lansley needs to be reminded that it is the tax payer who funds the NHS and not the Conservative Party. To safeguard our interests, an amendment must be added to the white paper that states that any private company, who has been found guilty of fraud within the UK or otherwise, should not be allowed to run GP Consortia.

It is naive to the point of being dangerous to assume that we can rely on Andrew Lansley’s promise alone that GPs or their consortia will not profit from the reforms especially when they make their commissioning decisions in private. Further it is disgraceful that loopholes have been written into a white paper where Lansley considers a one line reference with regards to conflicts of interest to be good enough to protect the interests of the tax payer. Therefore I further propose that the white paper should be amended to state that private companies running a consortium are disbarred from awarding contracts either to their own companies, or other companies that they have a financial interest in. If Consortia are discovered to be turning under spends into profit, or sending patients to their own private health companies, then they should be taxed at 100% and prosecuted for fraud. This is what it is called when the tax payer will be paying for patients to be treated, we do not fund it for companies like United Healthcare to make a fast buck or a billion out of us.

My real question is though, what questions are being asked regarding, the conflict of interest between Andrew Lansley, outsourcing companies and the White Paper? An outsourcing company that hopes to make millions of tax funded pounds from the shake up of the NHS has been revealed to be secretly providing the government with apparently independent GPs to help ministers sell their reforms to patients and staff. Internal emails obtained by SpinWatch show that the arrangement was agreed just before Andrew Lansley, launched his bill last month to scrap primary care trusts and hand £80bn of the NHS budget to private health companies.

Tribal, the outsourcing firm with £150m worth of government contracts supplied a list of friendly GPs to Bill Morgan, Lansley’s special adviser. Morgan is a former lobbyist for private health companies and Tribal confirms that it was in discussions with some of the GPs on the list about future lucrative contracts.

The government refuses to disclose Tribal’s list of tame GPs who stand to profit from the reforms . A health department spokesman said: "There is, and will be, absolutely no preferential treatment for the independent sector." Well if that is true, then there would be no problem releasing the list for public scrutiny would there? This is a time of austerity. Why is £3 billion of tax payer’s money, being wasted on dismantling the NHS, when no one seems to want them with the exception of Private Healthcare Firms, who are the main beneficiaries? I believe a judicial review should be held regarding the influence companies such as Tribal and Care UK had in drawing up the "reforms", when it is public knowledge that CareUK in particular funded Lansley when in opposition. This would ensure that the public would trust that the reforms are being made for patients, and not business interests alone.

5) David Cameron claimed during Prime Minister Question Time, that the Coalition have strengthened the white paper, "First of all, we have ruled out price competition in the NHS and also the issued raised by the Liberal Democrats which is, we must avoid cherry-picking by the private sector in the NHS." This is risible, you cannot rule out price competitions within the any willing provider model, when the right to fair and equal treatment will no longer be for patients but for the benefit of investors, who will use competition policy and trade law to demand a right of entry and a right to ensure that their services can continue to operate profitably. In like manner, you cannot avoid cherry picking of services when there is a free market free for all, or that is "any willing provider". Even with the Lansley amendment which is not workable, private providers will still be able to "cherry pick", for example by picking up profitable training contracts. Further, the commercial sector, unlike NHS public services, has market freedoms that the public sector does not - the freedom to levy charges and restrict care, and to downgrade or deregulate staff terms and conditions. The commercial sector's first duty is to shareholders and risks must be managed either by reducing staff wages and terms, cherry picking profitable patients and treatments, or by ensuring that it is not faced with the enormous costs of unpredictable care.

The NHS will no longer work co-operatively for patients but become a commercial business driven by competition. There is already enough evidence to prove, because of The Labour Party "reforms" where they handed taxpayers' funds to multinational companies, and remodelled the service along the lines of US healthcare, that there is a proven threat to the equity, value and quality of care by involving profit led companies in providing healthcare under NHS contracts. Independent Sector Treatment Centres cherry picked the less complex patients. Out of hours arrangements have caused unnecessary suffering, even deaths. The quality of work done in private treatment centres with NHS contracts has been criticised by NHS surgeons and has had to be repaired by the NHS. This is not good for the patient, is not a good return on tax payer’s money and gives the lie to the claim that providers will deliver care at NHS standards and within the price the NHS is willing to pay

Even the so called level playing field with regard to any willing provider, unfairly favours private health companies over the NHS. NHS Hospitals and community services are being forced into competition with private healthcare companies at a time when they are also having to make £20 billion "efficiency savings", but just to ensure that profits are sufficient to tempt private health companies (as if they needed it) into the market place Lansley advocates that private healthcare providers should receive a 14% premium above the fees paid to NHS providers. This is not a level playing field in any sense of the word; it looks like it might actually break competition rules, and that it would cost more to provide NHS services via private health companies than if NHS Hospitals and community services did so. Hardly a good return for taxpayer’s money. The government’s market strategy is neither supported by evidence nor consistent with the World Health Organisation policy , which rejects unregulated commercialism. It is likely to lead to service fragmentation, increasing inequities within and between populations, and higher costs. These will undermine the ability of the NHS to provide for the whole population

6) One great deception that is being promoted is saying to patients, "You and your GP will decide where you will get treated." Or put another way "there will be no decisions about me without me" That is simply not true. Unless the consortium of which the GP is a compulsory member has a contract with a particular hospital, the patient will not be able to go there from their GP. The patient is not at the centre of the reforms because any decisions regarding whether or not to fund treatment, is done in private. Concerns have already been expressed that complex illnesses will not be funded by Consortia because of their profit margin. Any "choice" the patient will have regarding being treated in our new model NHS, will be based on whether or not they have a top up insurance policy. Even then where "care" takes place will depend on the type of top up insurance policy the patient has purchased. This is after all a US model of healthcare. Should the patient have the misfortune not to have top up insurance because a) they cannot afford one, or b) they have the foolish belief that they do not need private health insurance because they are an NHS patient in a NHS Consortia, then they will have to go on a waiting list, where there is every possibility they will have never have the care that they have already paid for, via a National Insurance Stamp.

The government are using family doctors to sweeten the pill by presenting the changes as being GP-led; they tell us that as Primary Care Trusts are abolished they will be replaced by GP consortiums, led and operated by. This is a horrible and grotesque fiction. GP practices already have to compete for commercial contracts; soon these contracts will specify what services they can and can’t provide and determine which patients they can accept. The conflict between shareholders’ demands and patients’ needs will be ever evident to patients and public in day to day practice and services provided.

These reforms are driven by pure market ideology, without a shred of evidence that they will benefit the English population as a whole. On the contrary, all the evidence shows that if you create a US healthcare system the result will be denial of care and exorbitant costs for the taxpayer and the patient as private sector providers hold the government to ransom. Consortiums are to be granted extraordinary new powers: the power to deny care, to close and erase NHS services and to introduce charges, top up fees and sell private health insurance. The private sector providers too will have extraordinary new rights. The right to fair and equal treatment will no longer be for patients but for the benefit of investors, who will use competition policy and trade law to demand a right of entry and a right to ensure that their services can continue to operate profitably. 

7 ) I am absolutely incensed by the inference throughout the white paper that I am a consumer. I am neither, I have no choice when it comes to the NHS, tax is deducted at source. I am a patient, a taxpayer, sometimes even both, but not a consumer. If you want to make me one, you have to give people an opt out clause, otherwise if I am not using the NHS, then to use a market based approach then I am paying for someone else’s bills. Therefore as long as I am forced to fund the NHS then I would expect a good return on my investment. The reforms aren’t it. Lansley keeps telling us that under Labour NHS spending rose to European levels but it was so tied up in red tape it was unable to deliver European levels of quality health care. What he is not saying is that the red tape was caused by the market, where the huge investment into the NHS by Labour was diverted not into direct patient care but marketing, billing, invoicing, chief executive-level salaries, profits, shareholders' returns and bank dividends. Budgetary controls that made the NHS the most cost-efficient health system in the world were dismantled in the rush to market. It will not be any better under "any willing provider", costs will go up and health inequalities will widen.

In a speech on 14 October 2008, Dr Margaret Chan, WHO Director General, said:

"Some of the greatest waste and inefficiency occurs when health is treated as a commercial commodity, to be bought and sold, assuming that market forces will somehow self-adjust to iron out any problems. This seldom happens. What you see instead is unnecessary tests and procedures, more and longer hospital stays, higher costs, and the exclusion of people who cannot pay."

There is no systematic scientific evidence that market competition, even if achievable, will reduce costs while retaining quality and universal access; it is axiomatic in health economics that a perfectly competitive health care market is unattainable and that therefore market competition cannot be relied on to lead to cost efficiency. Scientific evaluation of the impact of competition on solidarity (cost-sharing across a whole population) is very poor, and therefore the risks for universality are unwarranted.

We are assured that the reforms are going to save £5 billion but The Health Service Journal calculates that the new model could cost £1.2 billion more than the current one. York University has estimated that the internal market has increased admin and management costs from a pre market NHS of 6% to 14 % of the NHS budget - and yet incredibly the Coalition are proposing in a time of austerity to extend this market. On top of this it has been estimated that the process of restructuring alone will cost between £2-£3 billion, so what is the rationale behind the reforms and where are the savings that are supposed to found by these reforms?

If Labour’s market based approach with regards to health did not significantly improve outcomes or decrease health inequalities what makes Andrew Lansley think that his reforms will fare any better? If you create a US healthcare system that is what you will get and the result will be denial of care and exorbitant costs for the tax payer as private sector providers hold the government to ransom. As a tax payer, this doesn’t sound like an awfully good return for my investment. David Cameron says change is not an option, well actually David it is when I am paying for it and private companies will profit from my money, at no benefit to me what so ever,

I am fundamentally against these reforms because there is no benefit to the patient, or the tax payer what so ever. In fact it is the worse of both worlds where tax payers are funding private providers to make an obscene amount of profit out of us, when we already know that it will lead to poorer quality health outcomes and further health inequalities. It is pure market ideology and without a shred of evidence.  On the contrary, all the evidence shows that if you create a US healthcare system that is what you will get and the result will be denial of care and exorbitant costs for the tax payer and the patient as private sector providers hold the government to ransom. For the first time in the history of the NHS we are seeing the emergence of commercial corporations’ influence over GP services where, as in the US, primary care providers will be orientated towards business interests.

9) The Governments real NHS prescription is:

More waste - £5 billion drained from patient care

More waiting - Cuts and closure as competition bites

Less Care - clinical decisions undermined by business motives

Less Fair - paying patients jump queue for NHS services

March 2011