The NHS Bill (again!).

I have been to a few events to do with the NHS Bill recently. I feel it is so hugely important but even I am starting to feel a little frustrated! I have now been to two lobbying events organised by 38 degrees where we lobbyed Southport MP John Pugh. At the first meeting the 38 degrees petition was presented, you can sign it here if you haven't already. The second was a follow up meeting. I have also attended the Socialist Health Association meeting with John Pugh, David Wrigley (a GP involved in commissioning) and a union representative (I didn't catch his name!).

What has come over consistently from Dr Pugh (who is an academic doctor rather than a medical one) is what I really believe to be at best a foolishly naive belief that the NHS bill can be effectively amended so that a satisfactory compromise can be found and at worst a priority given to putting Liberal Democrat principles of accountability and democracy into a bill that isn't right as a trade off.

At all three meetings, as might be expected since we were all people interested and likely to be opposed to the bill, the overwhelming atmosphere of desperation was palpable. People really seem to feel, as I do, that if the bill is based on three core principles of choice, competition and private sector involvement then the bill cannot be amended.

Further to that I personally believe that in a bill with those aforementioned core principles, some of Dr Pugh's planned principles for amendments stand a good chance of actually making the effect of the bill much worse, particularly for those who have great medical need but are either not empowered or unable, possibly as a result of their condition to make their need known. People who are mentally ill, unconscious, who cannot speak, who are housebound, disabled, elderly, children e.t.c. If we introduce competition, choice, private sector involvement and democracy in planning there is a large possibility that not only will services be patchy nationwide but that people will be making profit from healthcare and able to lobby politicians for contracts, it will be difficult to co-ordinate, plan and implement nationwide public health initiatives and, healthcare will likely be planned around the desires of those who shout the loudest, have the most power and wealth rather than the needs of anybody, but particularly not the needs of those without voices, power or wealth.

Fundamentally my position is this. The NHS was not broken, why try to fix it? Yes there will be costs, great costs, financial, organisational, structural e.t.c. in reversing the changes already being made in preparation for the bill, but the NHS was doing brilliantly before the bill started eroding its achievements and the morale, job security and pay of its staff. Changing the system in any way is risky. Implementing a bill which based on dangerous principles but has been amended is even more risky. Healthcare is too important to gamble with.

The Conservatives have made many unfounded and disputable claims about the NHS' performance. Dr Pugh is frightened of the PCTs. The fact remains that the NHS had reached record levels of satisfaction amongst patients and was on target to outperform other european countries this year as well as being widely respected and rating highly in many worldwide measures of healthcare. Using words like "health economy" and "private sector involvement" the coalition plan to make healthcare more like the american system which is widely renounced and does not achieve either cost effectiveness (it costs twice what the NHS costs in terms of percentage of GDP and produces worse outcomes) or high ratings amongst analyses of developed country's health outcomes.

I have written before about who benefits and why they do in the american system in this post about the public engagement meeting with Jonathon Parry and the Socialist Health Association has written a very good response to the bill here.

The main thing I am angry about is the proposal for profit making business to be even more involved in health and social care than they already are. It is not acceptable that anyone should profit from health and social care. Not ever. It is unnecessary and offensive. It is as offensive as gas companies making profit for shareholders out of a winter where people have died as a direct consequence of fuel poverty. An absolutely disgusting, immoral and despicable principle which should be opposed by every cell of every body of every person living in this country, or elsewhere for that matter. It is blood money.

Another thing is the strange contradiction offered up by changes to the secretary of state for health's role. The minister appears to be no longer required to achieve health outcomes but is given unprecedented levels of power to appoint and decide the pay of every key decision making role. A significant weakness when considering our current SoS who has previously taken tens of thousands of pounds in personal donations from private healthcare companies. You might also ask whether the priority role of the SoS for health is to appoint directors or ensure health outcomes are achieved? You might guess what I think!

Ensuring the NHS is working well will now fall to local authorities and the regulator (monitor) will ensure patient's interests are represented. This is the part where I feel Dr Pugh unravels. I am by no means against patient involvement or accountability or considering the views of the populace. By making local authorities responsible for public health you undermine public health efforts - divide and conquer. Public health is a national issue and must be treated as such, must have national priorities and be lead from the top down not the bottom up or it risks another cliche - too many cooks spoil the broth.

We have all seen how regulators of previously nationalised industry have performed in achieving representation of service users interests. Regulators are toothless. Once an industry is privatised or there is "private sector involvement, there is no duty to the public, no transparency, no accountability, no protection offered by public law and public governance. Regulators like Monitor at best can write to providers to say "excuse me you are not really doing what we'd like you to" and that is all. There is no law or regulation or other method to force them to comply as there is when an industry belongs wholly to the people. Relying on a regulator is that very last thing we want.

Dr Pugh believes the PCTs are undemocratic, unaccountable QUANGOs. He wants to replace them with a democratic system which most people feel is failing to be accountable or democratic and a few different larger QUANGOs - Monitor and GP Consortia. People who work in the PCTs say they are a vast improvement in terms of democracy and accountability than what went before and have duties to consult and involve patients as never before. My limited experience leads me to agree.

The patient satisfaction statistics and health outcomes are what really matter to me though. Patient satisfaction was at record levels, health outcomes were good, were also improving and importantly the NHS as a system was respected and valued nationally and worldwide. Why change? If a change is needed it should be justified. Each plan should be explained and demonstrated to offer improvement. The onus is not on those opposed to the bill to prove why it is bad but on the government and the SoS not just to prove it won't damage the NHS but to prove it will improve the NHS.

What we are seeing is a pause in the process advertised as a pause to listen and engage. This is followed by a statement basically saying that the failing is that the SoS has not explained how good the bill is effectively enough without any visible attempt to explain why it is good. This harks back to Nick Clegg's Tuition fees "you just haven't read the plan properly, if you did you would see it was better" arrogance. It is behaviour even Dr Pugh has moments of half subscribing to.

The pause meanwhile has basically pushed a decision about the Bill off the agenda for this year as it is unlikely to progress into the Lords until after October due to the parliamentary recess. In the meantime preparations for the bill continue full pace. Redundancies being offered, PCTs evaporating Southport hospital halving the number of wards, preparing to become a Foundation Trust e.t.c. The pause is actually a pause to ensure the bill damages the current structure enough that once the bill gets to the lords where it is likely to be thrown out the NHS will be so broken that something will have to be done. The Government no doubt hope that this will force the Lords to accept the Bill as the best of a bad situation. Be wary, no is the time for comprehensive opposition of the bill for this reason.

Back to Dr Pugh. He pronounces regularly that ordinary people do not understand or are bored by the complex processes involved in running the NHS such as strategic health authorities and primary care trusts. This is not what I have seen. I have met very many people who do understand, who have intimate understanding, possibly more so that Dr Pugh or other MPs themselves. People who have worked in the NHS, people who are interested. My argument would be if people really do not understand surely it should be explained? I find the assertion that people get bored of it or can't be bothered or don't understand the complicated business of Parliament fairly offensive - even if there is a possibility it is true! It isn't best to say "alright dear, I know more so I'll decide for you". MPs are not specialists themselves. It is important to remember that they are ordinary members of the public who have been voted into a position of power - if it is possible for them to learn about the complicated business of parliament it is possible for anybody to learn. Explaining these things will benefit people and engage them with politics.

The Socialist Health Association meeting was fiery. Dr Pugh was pressed. What failed to come across effectively was that a member of the public who kept asking whether he would vote against the bill was really asking whether he is fundamentally opposed to the bill. Generally, the people who are opposed believe the bill cannot be amended and must be thrown out. The liberal democrats are in a party political position where compromise is incentivised and what I am concerned about and what I assume this lady was concerned about is that Dr Pugh had not forgotten that his first responsibility is to his constituents, his second to national public interest and his very last to his party.

It is the liberal democrats, I would assert, who are seeking to amend the bill in an attempt to maintain the stability of the coalition. The priority should never be maintaining the coalition. It is more important to ensure the legislation the Government passes is in the interest of the public not the party and I would like Dr Pugh to think hard about whether party priorities are truly what is behind his eagerness to amend the bill. Attempting compromise is an admirable trait but one that, in this case, I believe is entirely counter productive when thinking about the public interest and that when it comes to matters of principle is largely unhelpful. Compromises should not be at the entire cost of principle, need or the public interest.