It’s increasingly hard to find anyone apart from Andrew Lansley and David Cameron who supports the Health and Social Care Bill. Most doctors, nurses and other NHS workers are against it. A Cambridgeshire GP who used to be the vice-chairman of his local CCG and an enthusiastic supporter of the reforms has written in the BMJ that GPs were 'duped' and the bill will 'wreck the NHS'.
Lib Dems are speaking out against it, and even Tory cabinet ministers have said that the bill could make the party unelectable. More than 130,000 people have signed a petition demanding that it be dropped. Roy Lilley at nhsmanagers.net gives seven simple reasons why it should be.
A few days ago the Lancet published an article by Nick Black of the London School of Hygiene and Tropical Medicine disputing the government's main justification for the reorganisation of the NHS: that it has suffered from falling productivity since it was given all that money by Labour 15 years ago. Black argues that this is a myth and, if anything, NHS productivity probably went up in that period.
Another piece in the Lancetwarns that the bill as it stands will allow for the end of free healthcare for all in England:
The Government's continued insistence on its structural changes and its failure to provide an adequate account of why they are necessary confirms concerns that the policy rationale has not been fully disclosed. The Government says that its changes are “vital”. But this is only the case if the object is to create a system that permits alternative funding sources for services currently provided free as part of the NHS.
Most damagingly, risk reports from the four regional strategic health authorities have found that the bill is likely to compromise patient safety: the London SHA identifies a significant risk of 'preventable harm to children' and of patients being ‘exposed to unsafe systems/processes which could cause them harm’.
But the Health Bill is by no means the only, or even the biggest, problem facing NHS staff. Funding cuts mean that hospital waiting lists are growing and Primary Care Trusts trying to stay within budget are increasingly restricting access to treatment.
Possibly the ugliest cost-saving measure, however, is the 'list-cleansing' exercise recommended by NHS Primary Care Commissioning. In order to eliminate 'ghost patients' from practice lists in line with government targets, NHS managers are being advised to write to patients over the age of 90, immigrants and people living in multi-occupancy households. If they do not respond, they will be removed from their GP’s list on the assumption that they are either dead or have moved away. Having fallen off the NHS radar, they will not receive follow-up care or be told about screening or other health initiatives unless they re-register.
Last year a similar scheme wiped 38,000 patients off practice lists in one PCT, leading to widespread outrage among GPs:
The very essence of the NHS is on the line here. If our most vulnerable in society cannot be protected and if we are excluding ethnic minorities by allowing this action to proceed unchallenged then the NHS really is in its terminal phase.
The whole point of these initiatives is not to produce validated lists, but to deregister as many patients as possible.
Meanwhile, doctors may soon go on strike for the first time in 40 years because of the threat to their pensions. The BMA is set to hold an emergency meeting on 25 February to discuss a ballot for industrial action if Lansley continues to refuse to reopen talks. The pension is the main financial incentive for doctors to work within the NHS. Take it away and many of them, already thoroughly demoralised, may well decide to work in the private sector instead. Even if the bill fails to go through, the coalition government may yet oversee the privatisation of healthcare and the end of the NHS.