[OccupySheffield] Read this – and prepare to fight for your NHS

[Public Wantchange]

If you don't yet understand what the government's changes for our NHS mean, read this.

Read this – and prepare to fight for your NHSI support the NHS because countless pieces of international research have   shown it to be the fairest and cheapest way of providing health care. 'The NHS will last as long as there are folk left with the faith to fight for it' - Aneurin Bevan meeting NHS patients in 1948 Photo: HULTON/GETTY 							By 											Max Pemberton, in 'The Daily Telegraph'6:27PM GMT 26 Feb 2012 There are few pieces of legislation that have caused such debate, furore and   confusion as the Health and Social Care Bill. Since I started writing about   it more than a year ago, I have received many letters and emails about it.   Readers are concerned – but also deeply confused. They are not alone. Fellow   medics, managers and nurses have cornered me in the hospital canteen and   quizzed me about it. I have even been invited by members of the House of   Lords to meet and explain it to them.
 
I am not surprised that people are confused. I’ve spent many hours immersed in   the Bill and in the subsequent amendments, drafts, briefings, notes and   critiques and I can attest that it is a particularly complex and obtuse   piece of legislation – and about three times the length of the 1946 Bill   that brought the NHS into existence.
 
But if this Bill is passed, it will lead to the most extensive reorganisation   of the NHS ever undertaken, so I think it’s vital that everyone understands   it so they can decide for themselves if this is what they want for the NHS.   The Bill addresses the way that the structure and delivery of health care in   England (although not Scotland or Wales) is organised and managed. It   eradicates the existing Primary Care Trusts and Strategic Health   Authorities, introduces a new structure and gives existing organisations   such as Monitor (an “economic regulator”, see below) and local authorities   additional powers.
Let me make clear: I am not ideologically wedded to a nationalised health   service. My only concerns are that access to health care is affordable for   all and that it is equitable. For me, it is a fundamental part of living in   a fair, just society that all members are free from the fear of destitution   should illness befall them. When a cohort of people live in the shadow of   the fear of sickness, society is impoverished and weakened. The reason I   support the NHS is because countless pieces of international research have   shown it to be the fairest and cheapest way of providing health care. If   another model is proposed that improves on this, then I am all for it. My   concern is that this Bill and its subsequent amendments fail to safeguard   the core principle of universal and equitable access to care provided by the   state, and the duty the Secretary of State for Health has in ensuring and   protecting this. To help Telegraph readers assess the implication of the   Bill, I am devoting my column this week to highlighting my main areas of   concern:
The role of the Secretary of State for HealthUntil now, the health of the nation has ultimately been the responsibility of   the government, with ministers directly accountable for providing or   securing a comprehensive NHS. There are various parts of the Bill that   either directly or indirectly alter this. Under the Bill, no single person   and no single organisation will be responsible for meeting all the health   care needs of all the people living in England or specifying the services to   which they are entitled. A number of different bodies will have the power to   determine the health care you can receive through the NHS.

Clinical Commissioning Groups and local authorities
The power to determine the services that make up the NHS will be transferred   from the Secretary of State to newly created Clinical Commissioning Groups   (CCGs), which are unelected. Members will include GPs but also company chief   executives who can, if they wish, outsource decisions about the appropriate   level of services offered to companies with commercial interests. This is   what the Government means when it says it is handing GPs £60 billion of NHS   money. Services such as mental health provision, facilities for pregnant   women, preventive medicine, aftercare and services for children could be   substantially reduced by this power to save money, generate revenue or   redirect patients into the for-profit sector. In addition, the government is   planning to establish a parallel health service whereby some services,   including screening, immunisation and vaccination will be handed to local   authorities with the discretion to decide what will be provided, and to   whom. This means that some services that were formerly free on the NHS may   become chargeable, as under these changes, CCGs and local authorities will   have the power to make unilateral decisions about what can and can’t be   provided. 

Monitor 
Many of the Government’s current powers and responsibilities for health care   will be handed over to an economic regulator known as Monitor. This quango   is composed of unelected and unaccountable individuals. It will not have   overarching responsibility – which the Government does currently – to ensure   that everyone’s health needs are met. Instead, one of its main concerns is   economic viability. It will have the power to decide, on purely financial   grounds, if an area loses its existing range of hospital services, such as   A&E departments, with no duty to consider alternative provision. 

Patient care With so many different providers of health care created under this Bill, those   with complex health care needs may not receive the joined-up medical care   that the NHS now works hard to provide. Also, providers will come and go   over time, as services prove themselves to be viable revenue generators or   not. This risks disruption and confusion for patients with a marked   discontinuity of care. Less profitable patients – those requiring complex   levels of care from multiple individuals and areas of expertise, for example   – may be sidelined by these private companies.

The Risk Register
The Government has already conducted an assessment of the financial and public   health risks of implementing this Bill in a document called the “Risk   Register” but has so far refused to release this information for independent   analysis. On November 2 2011, the Information Commissioner ruled that the   Risk Register relating to the Bill should be released. The Government has   refused and has launched an appeal against the decision, further fuelling   suspicion as to what it contains. 

Commissioning
Despite the political rhetoric, nowhere in the Bill does it actually state   that GPs are required to do the commissioning or purchasing of services in   the new market. In reality, it is likely that few will be able to show the   necessary competence in the highly technical business of buying health care.   Instead, the Bill allows CCGs to contract out commissioning functions to   private accountancy, health insurance and management consultant firms, which   will be able to decide what care is provided free at the point of use   through the NHS and what is not. This means that profit-making companies   will be able to provide your clinical care and also decide what you’re   entitled to under the NHS and from which care providers. Companies will also   design and set the care targets that doctors must meet. There is the   potential for commercial conflicts when the needs of shareholders come   between doctors and patients.

Community services, hospitals and private patients
Providers, too, can reduce levels of service provision and entitlement to   NHS-funded care and there are no restrictions on charging for non-NHS care.   The ''autonomy clause’’ in the Bill gives CCGs and providers extraordinary   freedom. We have already seen some CCGs refuse operations for obese   patients, despite national guidelines stating their obesity should not   preclude them. The Bill also increases the current cap placed on hospitals   regarding the amount of income they can generate from privately paying   patients. Now, up to 49 per cent of income can be generated from private   income. This means that almost half the beds currently used for NHS care   could be given over to private patients. This could create a two-tier system   in hospitals and drain resources, as well as create a conflict of interest,   with hospitals having a clear incentive to encourage as many patients as   possible to use the private half of their facilities. Moreover, hospitals   can decide when to discharge patients. The requirement for coordinated   discharge and aftercare of patients between health and social care is   abolished in the Bill.

The Government has tried to silence critics of the Bill by claiming they are   distorting or misrepresenting the legislation. But the points I’ve raised   are in the detail of the Bill, there in black and white, for all to see. It   might be that none of this concerns you – or you may be horrified. Whatever   your political leanings, health status or experiences of the NHS, it is YOUR   health service and I believe you have the right to be informed about what   the proposals set out in this Bill will mean for the NHS. I think most   people simply want a health care system that is there for them when they   need it, that provides good, efficient service and that treats them with   dignity and respect. They want a fair, just system that looks after   everyone, regardless of their ability to pay or the complexity of their   needs. I shall leave it to you to decide whether this Bill is safeguarding   what has, until now, been the ruling principle of one our most valuable   institutions – the NATIONAL Health Service.






  

 		 	   		   		 	   		   		 	   		  
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