Health and Social Care Bill

Memorandum submitted by Michele Bohan (HS 40)

1. £20 Billion in cuts is already causing Rationing in the NHS – the Health & Social Care Bill will lead to further chronic cuts with potentially fatal consequences.

Mr Cameron claims his reforms are not about "cutting services" but about increasing "choice" for patients. Not so. Patients will have "no choice" when rationing and frontline services are already being cut. Can the Committee explain why patients (who will drive these reforms according to Mr Cameron) have not been consulted on them?

FACT: A recent government directive has stated that : "operations which will only be carried out in exceptional circumstances include, removing tonsils, varicose veins, hysterectomies, fitting grommets, removing skin lesions, haemorrhoid surgery, wisdom teeth extraction, cataracts and joint replacements sic". In Total 57 different procedures will only be carried out "in exceptional circumstances." However many of these so called "minor procedures" can often mask or lead to serious, sometimes fatal conditions if left untreated, including "Peritonsillar abscess or tonsillar cancer. Skin lesions can become malignant and cancerous. Untreated Cataracts can lead to blindness, yet these cuts are already being implemented in many areas of the country. So the Coalition is denying patients treatments that could lead to chronic and potentially life-threatening conditions

It has also also been stated that elective operations (including Cardiac, Vascular, & Orthopaedic procedures) with an 80% success rate will be categorised as "of no clinical value" and will be stopped! Perhaps the Committee might want to ask the millions of patients with debilitating conditions like Angina whether an "angioplasty" (one of the elective procedures at risk!) is "of no clinical value" to them and their quality of life? Not only can an angioplasty restore a patient's quality of life (as well as their economic contribution!), but without intervention their condition will invariably deteriorate and become acute or even fatal - and will cost far more to treat in the long-term.

Can the Committee justify to long-suffering Patients here in the real world,(far removed from the privileged, Palace of Westminster) why they are being refused operations which can not only clinically restore their "health and quality of life but often prevent their condition deteriorating further (thereby requiring major surgery at huge cost to the NHS!)?

How is this right, compassionate or fair? The cuts proposed in the Health & Social Care Bill are wrong, uncaring, and unfair and give patients "no choice" whatsoever in how they are treated. How can patients "choose" operations/treatments that the Coalition have scrapped? What right has the Coalition to decide which operations/treatments are "of no clinical value" to patients?

The rationing of even minor operations can be debilitating for patients, put their lives at risk, and cost the NHS far more money to treat in the long run. This issue needs to be looked at and amended.

2. Why is £80 billion pounds of public money to be handed over to GPs with no experience of commissioning health services and why are GP’s to be awarded cash bonuses for running the consortia!

Handing the bulk of NHS spending to GP's who are trained in Medicine not Business (and who are "General Practitioners" not specialist, experienced Consultants and Surgeons) is a potential disaster which will increase rather than decrease health spending. Administration costs will simply be shifted from the PCT's (due to be abolished) to the new GP consortia who will hire in private sector consultants and advisors to add another level of bureacracy! GP's are also to be given "performance bonuses" for running the consortia and will be allowed to set the payscale of their CEO's and Directors – which could result in boardroom salaries of £250.000 - £500.00! So money that should be spent on patient care will go straight into the pockets of GP'S! If the GP consortias run out of money, the Government claim they will not be bailed out and will be allowed to fail!

So apart from the inherent risk of a "postcode lottery" resulting from 500 GP consortia all being free to set their own priorities for the healthcare they commission, patients will find that the care they receive will depend not on their "clinical need" but on the financial success of their GP consortia. Also, if GP's are going to be engaged in running multimillion pound empires - when will they actually see their patients which is what they are paid to do? There are rumours that Patients will soon have to ring a call-centre to book a GP appointment - how long before the call centre will be moved to India and the GP consortia to an oversease tax haven? These reforms will destroy the relationship between GP's and their patients or "customers" as they will soon be called! If GP's spend all their budget (on bonuses and private advisors) - patients requiring hospital treatment will be told "sorry, but you’ll have to wait until the next financial year" - resulting in prolonged pain and misery and a decreased quality of life.

Can the Committee explain how handing the bulk of the Health budget to GP's as well as huge performance bonuses (for doing a job they have chosen to do!) - then allowing them to go bust if they run out of money - is going to enhance patient "choice", improve our "quality of care" and provide a better deal for the taxpayer?

Can you also advise what will happen if and when GP Consortias do fail? What will happen when sick and vulnerable patients need treatment but there is no money left? WHAT WILL THE COALITION DO THEN, STAND ASIDE AND ALLOW PEOPLE TO DIE? We need to know because these are your policies and you will be held responsible. What controls will be put in place to stop GP consortia squandering public money on themselves and their bonuses rather than patient care? This issue needs amending to prevent this happening.

3. Why are Private Health Firms to be paid 14% more for providing services to the NHS despite the danger to the equity, value and quality of care to patients posed by profit-led companies?

Under this Bill, "AWP's" - "Any Willing Provider" from Europe and beyond will be free to bid for and run services in this country and are to be paid 14% more for their services - WHY? Unknown, untested, companies with possibly unqualified, untrained, staff will be free to cherry-pick the less complex/(more profitable)patients. There is a huge risk to patient care posed by unregistered companies motivated by profit with no evidence of the quality of their services and their clinical outcomes? The quality of work done in private treatment centres with NHS contracts has been criticised by NHS surgeons and the cost to the taxpayer is much more!

Fact: My sister was referred by her GP to a Private Sector Provider in Manchester for minor "keyhole surgery" on her knee. She was cajoled with claims of no waiting time, simple day-case procedure, carried out at a local private hospital by a reputable surgeon. She was left crippled, in constant pain and on morphine as a result of her "private" operation! She had to be re-referred to an Orthopaedic Surgeon at the Manchester Royal Infirmary and is now on the waiting list for a full knee replacement as a result of her botched keyhole surgery! How is this an example of "better patient care" and a "better deal for the taxpayer". How many other "2nd rate" private sector procedures are having to be put right by qualified, reputable NHS surgeons up and down the country? How much is this reparative surgery costing the NHS? Perhaps the Committee could find out?

I ALSO ENCLOSE FOR YOUR INFORMATION SOME ARTICLES ABOUT TWO PRIVATE SECTOR COMPANIES: "MANCHESTER CATS" and "NETCARE" - both of whom were paid huge amounts of public money upfront for services they failed to provide - because patients didn't want to use them!)

Can the Committee explain exactly how this is an example of both "competition improving services" and "good value" for the taxpayer when Private Companies are being paid over the odds for services they don't provide, courtesy of the public purse?

What measures will be taken to ensure that the quality of care to patients is not jeopardised by unchartered independent providers trying to undercut local hospital with "cut-price" sbstandard treatment? ? These companies must never be paid more money for their services!

Will these companies have to operate under the same stringent "Clinical Governance" guidelines as the NHS? How will data on their training, treatments, clinical practices and clinical outcomes be gathered to ensure quality of care? Will patients be able to access this information in order to decide whether they wish to be referred to one of these services? Will GP's be coerced into using "AWP's" at the expense of their local hospitals to satisfy the "market competition" criteria? This issue needs scrutinising and amending.

4. Who will regulate these Private Sector Businesses and Advisers and oversee their business practices?

Who is going to be responsible for vetting these "AWP's" and holding them to account in order to protect the interests of patients and the NHS itself? How are we to prevent unscrupulous companies like United Healthcare (an American firm bidding to run services here) - which has been fined millions of pounds over a number of years for defrauding the American healthcare system doing the same thing here in the UK? Their offences involved "cheating patients out of money", "denying treatment" and "overcharging"! Should firms like this even be allowed to operate in this country, let alone be allowed anywhere near the NHS budget?

What policing and vetting procedures will be put in place to prevent fraud and abuse by Private Sector Companies. This is a hugely important issue that could have devastating consequences for the safety of patients, the NHS itself and the public purse? There needs to be stringent monitoring of these companies, the quality of their services and the price of their services.

5. Who will be held to account when it all goes wrong?

What happens when the governing bodies have all gone? When the Strategic Health Authorities, the PCT's, NICE are all abolished? Who will be overseeing and taking responsibility for this new NHS? Who will be held to account when the GP consortias run out of money and fail, when waiting lists are growing, when operations are being cancelled, when treatment is denied,when medication is withdrawn, when services are cut, when frontline staff are axed, when hospitals are closed, when patients suffer and patients die?

The Coalition Government (unelected and with no mandate) will be held responsible by the British Public and will pay the price for this ill-conceived, ideologically driven, destruction of the NHS. Mr Cameron claims that "patients will drive the reforms" yet we have not been consulted, why? The Coalition government is gambling with the NHS and gambling with our lives - surely we have the right to have our say?

The Committee must consider the implications of these reforms and how each and every one of us will be affected by them. Amendments to the Bill need to be made to protect the quality of care patients receive and to ensure that rationing of operations which can cure conditions and restore a patient’s quality of life is stopped! GPs should not be paid bonuses, nor profit from public money that should be spent on patient care. Private companies need rigorous policing to protect patients and to ensure the highest quality of care and they must never be paid more for services they provide to the NHS.

February 2011