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<font style="font-size: 12pt;" color="#c00000" size="3"><strong>If you don't yet understand what the government's changes for our NHS mean, read this.<br></strong></font><br><BR><div><div dir="ltr"><div><div dir="ltr"><div><div id="ecxSkyDrivePlaceholder"><h1><font style="font-size: 24pt;" size="6">Read this – and prepare to fight for your NHS</font></h1><h2>I support the NHS because countless pieces of international research have shown it to be the fairest and cheapest way of providing health care. </h2><h1><div class="ecxartIntro"><div id="ecxstoryEmbSlide"><div class="ecxslideshow ecxssIntro"><div class="ecxnextPrevLayer"><div style="display: block;" class="ecxssImg"><img alt="'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 - Read this – and prepare to fight for your NHS" src="http://i.telegraph.co.uk/multimedia/archive/02151/81150896_2151116b.jpg" width="620" height="388"><div class="ecxartImageExtras"><div class="ecxingCaptionCredit"><span class="caption">'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</span> <span class="ecxcredit">Photo: HULTON/GETTY</span></div></div></div></div></div></div></div><div class="ecxoneHalf ecxgutter"><div class="ecxstory"><div class="ecxcl"><font size="2"> </font></div><div class="ecxbylineComments"><div><p class="ecxbylineBody"><font size="2"> By </font><a title="Max Pemberton" href="http://www.telegraph.co.uk/health/healthadvice/maxpemberton/" rel="author" target="_blank"><font size="2"> Max Pemberton</font></a>, <font style="font-size: 10pt;"><font style="font-size: 12pt;"><font style="font-size: 16pt;" size="4">in '<font style="font-size: 16pt;" size="4">The Daily Telegraph'</font></font></font></font></p></div><p class="ecxpublishedDate"><font size="2">6:27PM GMT 26 Feb 2012</font></p><p class="ecxcomments"><font size="2"> </font></p></div><div id="ecxmainBodyArea"><div class="ecxfirstPar"><font size="2">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.<br> <br></font></div><div class="ecxsecondPar"><font size="2">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.<br> <br></font></div><div class="ecxthirdPar"><font size="2">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.<br></font></div><div class="ecxfourthPar"><font size="2">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:<br></font><font size="2"></font></div><div class="ecxfourthPar"><font size="2"><u>The role of the Secretary of State for Health</u></font></div></div></div></div></h1><div class="ecxoneHalf ecxgutter"><div class="ecxstory"><div id="ecxmainBodyArea"><h1><font size="2"></font><div class="body"><font size="2">Until 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.<br><br><u>Clinical Commissioning Groups and local authorities</u></font></div><font size="2"><div class="body"><br>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. <br><br><u>Monitor </u></div><div class="body"><br>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. <br><br><u>Patient care</u></div><div class="body"><u></u> </div><div class="body">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.<br><br><u>The Risk Register</u></div><div class="body"><br>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. <br><br><u>Commissioning</u></div><div class="body"><br>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.<br><br><u>Community services, hospitals and private patients</u></div><div class="body"><br>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.<br><br>The Government has tried to silence critics of the Bill by claiming they are distorting or misrepresenting the legislation. <font color="#c00000">But the points I’ve raised are in the detail of the Bill, there in black and white, for all to see.</font> 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.<br></div></font></h1></div><h1></h1></div><h1></h1></div><h1></h1></div><h1></h1></div><h1><div id="ecxAutoCompleteTo$ResultsOuterContainer" class="ecxResultsOuterContainer"><div class="ecxACShadow"><div id="ecxAutoCompleteTo$ResultsContainer" class="ecxResultsDDownContainer"></div></div></div><input id="ecxAutoCompleteTo$SelectedContacts" value="" type="hidden">
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