Health and Social Care Bill

Memorandum submitted by Save the NHS Now (Ealing) (HS 127)

1. Organisation.

         The Secretary of State for Health will cease to be responsible for the operation of the NHS and devolve all responsibility to the NHS Commissioning Board. Yet the NHS is of supreme national importance. It is publicly funded. Health policy and priorities are of huge national concern. The Government minister for Health must remain responsible and accountable to the nation.

         As far as we are aware the NHS Commissioning Board will have no patient or clinical representation and its proceedings will take place in private. This must be rectified. It should have patient and clinical representation and its proceedings be open to the public.

         We are very concerned about Monitor’s role of enforcing commercial competition. Its prime duty must be to maintain and extend a co-operative healthcare system in the UK.

         Regional planning will be deleted by removing the strategic Health Authority. This could lead to a "post code lottery" in patient care, workforce availability and it poses a threat to UK wide medical training. Something must be put in place to rectify this problem.

         GP Consortia. We are very concerned that the Bill states these will meet in private, with press and public excluded and no requirement to publish board papers. Only one token public meeting per year is required. There should be places for elected members of the public, hospital and mental health clinicians. All meetings should be in public and minutes published.

         This Consortia structure unless amended makes the promise of patient involvement a lie.

         We, like the RCGP are concerned that there is an ethical conflict between GPs being required to economically manage a diminishing budget in the Consortia and doing their best for their patients. This needs to be addressed. A commitment in the bill is needed that GPs will still be able to provide the treatment for patients they feel most appropriate.

         The likely reality will be that the GPs will only have token involvement in the Consortia. They have neither the time nor the training. They will hand the commissioning job to private consultants or others leading to higher administration costs than the PCT system, not less.

2. Any Willing Provider. It seems there has been a "back track" on this and it could be possible in some cases that the Consortia can designate "a prime provider". This needs to be firmed up. Similarly regarding the assurance stated by Sir David Nicholson that there’s "no question" of introducing competition on price, we remain unconvinced. The market approach that colours this Bill will privatise, destabilise and fragment NHS services destroying the co-operative and unified service we now enjoy.

         We would want the NHS to be the preferred provider of services

         We agree with the RCGP that the phrase should be changed to "enough excellent providers" and the ability given to Consortia to make the decisions needed for local communities.

3. Foundation Trusts. We are very concerned that this status will be forced on hospitals. The limits on money FTs can earn from private medicine are to be scrapped leading to a likely increase in this sector due to diminishing budgets. Not good for NHS patients! It is still likely simpler services will be "cherry picked" by the private sector leaving FTs with the difficult work. If they cannot balance books they may well fail. It has also been stated FTs will be removed from the NHS/Treasury balance sheet and made independent social enterprises putting NHS terms, pay & staff conditions in doubt for health workers.

4. We remain concerned about many other issues such as:

         Treatments already being excluded from the NHS as spending cuts are sought.

         Responsibility for public health currently shouldered by PCTs to be passed to local Councils at a time when they are reeling from massive budget cuts.

         We understand the PCTs have 100+ other important functions than patient care commissioning and we have no clear idea to where these responsibilities will move.

There is probably much more in the 367 page document we are not yet aware of.

We hope you will consider these points and also see attached information from Medical Practitioners.

We would also point out that apart from private sector providers and management consultancies this bill has received virtually nothing but criticism from any think-tank, medical or academic professional body.

March 2011