November 10, 2014 by Protect Our NHS
The campaign to stop the destruction of the NHS involves many of us at local and national levels. This blog piece is about one of the most tireless activists for the maintenance of the founding principles of the NHS and his attempt to engage with his local MP.
For those of you who don’t know of him, Raymond Tallis is one of the leading campaigners against the destruction of the NHS under this coalition government. He is the co author (with Dr Jacky Davis) of the book “NHS SOS” which is a must read for all of us who care about what has and is happening to health services in this country – http://www.amazon.co.uk/gp/product/1780743289?*Version*=1&*entries*=0. Further information about Ray can be found on his website – http://www.raymondtallis.com/and in the ever reliable Wikipedia: https://en.wikipedia.org/wiki/Raymond_Tallis
The following letter was sent last month by Ray to his local Lib Dem MP, Mark Hunter.
I guess your heart will sink when you see that this letter is from me. However, I wanted to have one last go and then I will leave you in peace. Although I have written many books and looked after tens of thousands of patients in my 37 years as a hospital doctor, I feel that this letter – if it achieves what I hope it will achieve – may be more important than anything else I have written and most of my other endeavours for patients. Writing to you yet again reflects my belief – reinforced when we last met – that you got into politics for the same reason that I got into medicine: not for self-advancement but to help to make the world a better place.
There are several reasons why I am bothering you about this issue again. Since we last spoke about it, there have been important developments. They are set out on the Annex to this letter. I hope you can find time to read both the letter and the Annex. You will see that the latter confirms all the worries of those of us who were opposed to Lansley’s Bill.
It is now obvious to every dispassionate observer that the Act was not about improving patient care at all. It had two purposes: to facilitate privatisation (as Oliver Letwin, Andrew Lansley, and Jeremy Hunt had advocated when they were in opposition – though they deny it now); and to open up an accountability gap between what happens in the NHS and the government of the day, so that when things start to fall apart as the private healthcare providers divide the juicy bits up between them, our political masters can say ‘not me guv’. Lansley’s claim that the Health and Social Care Act 2013 (HSCA) was about ‘liberating the NHS’ from red tape was clearly untrue: we now have 440 bodies managing the service instead of the 163 there were in 2010. (Much of this is because of the huge managerial and clinical time wasted on drawing up tenders and running tendering processes.) Lansley misled parliament, he misled the people of Britain, and he misled his Cabinet colleagues (as they have now claimed).
Which brings me (at last you might think!) to my reason for writing to you now.
You will have seen reports that the Tories have now admitted that their £3 billion reorganisation was a terrible mistake. (The story was broken in The Times which is hardly a far left newspaper.) What is more, senior Tories (including Cameron and Osborne) say they did not understand what Lansley was up to. This, if true, is an astonishing admission of incompetence. Indeed it amounts to criminal negligence. They also said that they believed him when he claimed that his plans were supported by the medical profession. (The overwhelming majority of doctors were opposed.)
Now that even those who sponsored the Lansley Bill are distancing themselves from it – though the Tories have no intention of repealing a statute that will bring many of them personal benefits from their private healthcare interests – it would seem to appropriate for a person of integrity such as yourself openly to question, indeed challenge, the HSCA. There will be an opportunity for this. As you may know, Clive Efford is putting forward a Private Members Bill in the Commons in November. The Efford Bill, if passed, would remove the most toxic parts of the HSCA without involving a further reorganisation. Would you consider supporting this Bill, notwithstanding that Efford is Labour? Yours would not only be an important vote but it would send a powerful signal to others. You would have a huge influence – for good.
If the Act is not repealed either in November or in an Emergency Bill after the next election, and if the Tories are returned to power, then I am afraid that the NHS will be done for. It is already melting like a polar ice cap but “we ain’t seen nothing yet”. The pace of privatisation will quicken further and the consequences will be catastrophic. Over the next decade, we shall see a situation in which: some people will die or suffer chronically for lack of treatment; others will go bankrupt trying to make up for the shortfall in free provision at the point of need; and yet others (a wealthy minority) will receive treatment they do not need so that the private provider can shift more product. The ethos of the healthcare professions will change as they become loyal company men and women working to a contract rather than acting on a covenant. And the NHS, one of the most profound expressions of our collective values – which recognise our duty to help each other in coping with the lottery of life – will be largely parcelled out between a multitude of dog-eat-dog enterprises, competing rather than cooperating with each other. The NHS faces many challenges ahead so it cannot afford self-inflicted injuries.
Mark, I appeal to you to reconsider your commitment to what the British Medical Journal called ‘Lansley’s Monster’. Even though you were once a whip, if you conclude that supporting HSCA was a mistake, then please say so publicly and, if possible, vote for Efford.
If you feel you cannot do this, I won’t trouble you with more letters. I and many others of your constituents will still continue campaigning to fight the destruction of the NHS though it will be much harder without the support of our elected representative.
ANNEX – Developments in the NHS Post Lansley:
NHS Best in the World?
The Commonwealth Fund confirmed in 2014 that our, as yet incompletely privatised, NHS is the best in the world for patient safety, access to care, quality of care, and value for money. This was based on data obtained before the HSCA had started to bite. However, in the last year, – partly as a result of the cataclysmic disruption of the HSCA reorganisation – health care gains made in the previous decade are now going into reverse. (Cause for Concern Nuffield Trust and Health Foundation, 2014).
Privatisation so far and its Consequences
Privatisation is now picking up speed. The value of contracts put out to tender has risen three-fold between 2012-2013 and 2013-2014 and 70% of these have gone to the private sector. (NHS Consultants Confederation). The appalling behaviour of privatised health providers (see ‘The private sector provides letting down the NHS Margaret McCartney BMJ 11th October 2014) – Circle in Hinchingbrooke, Serco in Cornwall, Vanguard Healthcare in Somerset, Atos Healthcare in Tower Hamlets , Clinecenta in Hertfordshire, Arriva everywhere – are entirely predictable, though commercial confidentiality makes it very difficult for concerned citizens to track what is happening.
It is becoming clear that private sector bidders are better at tendering than delivering but when they walk away from contracts, or contracts have to be terminated for poor performance, they leave a terrible mess. The legal challenges from the private sector to cooperation between parts of the NHS that threaten their business models will be known to you. And we have TTIP in the background which, if negotiations go as the Tories wish, will result in all parts of the NHS being opened to competitive tender. Section 75 of the HSCA will achieve its full potential.
Undermining the NHS
The Secretary of State Jeremy Hunt under the HSCA does not, unlike his predecessors, have responsibility to secure comprehensive healthcare. As Jane Ellison, NHS Public Health Minister, stated “With the Lansley Act we [the Tory Party] have pretty well much given away control of the NHS”. Relieved of his responsibility for the organisation, Hunt has consistently attacked the NHS. His assaults on GPs are bearing terrible fruit. Recent data have revealed that applications for GP training posts (and GPs were supposedly at the heart of the new NHS) have fallen by 15% over the last year. (Source: BMJ 18th October 2014).
In another outburst of finger-wagging, Hunt has also claimed that mistakes are costing the NHS £2 billion a year. This assertion was based on a report (commissioned from an old mate), whose methodology beggars belief. (See Roy Lilley’s critique in nhsManagers.net Blog 17th October 2014 ‘Give Us Our Money Back’ ). However Hunt’s wickedly misleading message – intended to soften up the case for more privatisation – was clear: the NHS is dangerous. Actually, the Commonwealth Fund Think Tank found it was world-beating for patient safety, as I have already mentioned.
There is much more self-serving finger-wagging – such as talk of “naming and shaming” GPs who make mistakes – though all the evidence is that this approach will be counter-productive. (See, for example, BMJ 18th October 2014 ‘Intolerance of error and culture of blame drive medical excess’).
As was predicted and we feared, NHS provision is now becoming less comprehensive. It looks as if Monitor is restricting services. (See BMJ 11th October ‘A Wolf in Sheep’s Clothing’ Peter Roderick and Allyson Pollock). Slowly but surely healthcare free at the point of need will shrink, in order in part to pay for the excess costs of outsourcing services to the private sector.
AND AFTER THE MEETING WITH THE MP TOOK PLACE IN NOVEMBER…
Thank you for seeing us today. I realise that it was not a meeting of minds.
You took exception to the claim in our leaflet that the Coalition lied but, as you will see from that leaflet, all the evidence is there. We were not suggesting that you personally were a liar. I genuinely feel that you were misled – as the Tories now claim to have been misled by Andrew Lansley, though his destructive and wasteful £3.5 billion reorganisation has given them the instrument to sell off the juiciest bits of the NHS to their friends. I have no doubt about your personal integrity.
You were puzzled why we had not mentioned two other Stockport MPs Anne Coffey and Andrew Gwynne in our leaflet. This was because they voted against the Lansley Bill so we have no quarrel with them.
You challenged us to provide you with evidence that the Health and Social Care Act (HSCA) was damaging. I had thought this was covered in my letter and in our leaflet. However, there is further information in the NHS for Sale Website. A few keystrokes will get you there. Nationally, it is a terrifyingly fast-moving situation and the story so far is being summarised in a book by Jacky Davis and colleagues that is to be published shortly. I will make sure you get a copy. Locally we have disgraceful Arriva, Health at Home, and the bizarre use of One-to-One maternity services (and an inquiry into the deaths of babies) but this is just the beginning. Stockport, I am pleased to say, is (so far) behind the privatisation curve. But, if a Tory-led Coalition has control of our lives in 2015, then the NHS bazaar will really get going, with privately run Commissioning Support Units and other instruments being mobilised to sell off our heritage. Stockport will not be immune from this, though concerned citizens will have no chance of finding out what is going on until it is too late. As we mentioned, we already have a formal complaint with the CCG on this score.
We remain deeply puzzled why you hesitate to support the Efford Bill, given that much of it is in line with the aims for the NHS set out in the document that came from your own 2014 party conference. What is it about the Bill that you do not like? The BMA (hardly a Trotskyite organisation) has today declared its support for the Efford Bill as a step towards rectifying the damage done by HSCA: a move in the right direction. It represents 150,000 doctors not all of whom are idiots or left-wing ideologues.
You feel that supporting a Private Member’s Bill that does not have government support – and is therefore unlikely to progress – would be a mere gesture. To this, I reiterate what I said in my last letter: if you were to support the Efford Bill, this would send out a huge signal to the world at large that a) the HSCA was damaging and b) that (more importantly) further damage could be prevented. Your gesture, if that is how you see it, would be immensely powerful. If the Efford Bill gets little support, and the multinationals are not frightened off now, the NHS is done for. And if TTIP is not stopped in its tracks then the rate of disintegration of the NHS will accelerate and the end of publicly provided health care for all, free at the point of need, available irrespective of the means to pay, will come very soon. It may be 3 years rather than the 5 that I feared. (And of course TTIP will have a catastrophic wider effect on our democracy as anyone who understands its implications will appreciate.)
The destruction of the NHS. What a legacy for our children and grandchildren! And what a record for the Lib Dem’s first (and perhaps only) experience of government.