DANGER: Our NHS is under threat

I make no apologies for saying this again: the NHS is one of our greatest institutions. We should be proud of it and be prepared to fight for it. As Nye Bevan said, ‘the NHS will last as long as there are folk prepared to fight for it.’ Yet time and again our politicians tell us that the NHS needs huge reform, that it is underperforming and too expensive. Is this true? Let us look at the facts.

NHS performance has been analysed by many international bodies. All of them, without exception, report that the NHS performs better than almost all other health systems and that it has results as good as, or close to, the best in the world. Nobody is going to pretend that there are not things that could be done better. Of course there are. But is there any health service that is perfect? I challenge you to find one. The reality is that every health system has flaws, but that ours takes care of the most disadvantaged in our population and provides a level of care of which we should be proud.

So why, in a time when we know that the nation is cash-strapped, and huge savings have to be made in the public sector, is the Government choosing to embark on the most sweeping top down reorganisation the NHS has ever seen? Those of us who have been in the NHS a long time have seen many reorganisations. The truth is that, for front line staff, they often make little difference. For us in Public Health they tend to have more of an impact, as reorganisation impacts directly on our jobs. I remember, as a very junior registrar, being told by my then boss that he had had to apply for his own job seven times. We both laughed. At the time, I failed to understand the trauma that this could induce, but the truth is that the laughter was genuine because, whatever happened, the NHS went on and we were able to make the system work.

Then came Shifting the Balance of Power (unfondly known as StBoP). That was a big one. It caused much angst and disruption, we had total planning blight for two years, and then the NHS settled down. I don’t actually believe that anything improved because of StBoP, not did we save any money, but some politicians felt better for a little while. I may not have liked what happened, but we live in a democracy and I put up with it.

And now this. This is totally different. For the first time I am not prepared to ‘put up with it’. This is too important. Because this does not reorganise the NHS – it dismantles it. Do not be fooled by the weasel words. ‘You exaggerate’, I hear you cry. I only wish I did. The NHS was set up in such a way that the Secretary of State for Health had a duty to provide a comprehensive health service for all, free at the point of delivery. Free to all of us: you and me, those we love, those we don’t like, those we admire, those we despise, the rich and the poor, those who live in palaces and those with nowhere to lay their heads. That, basically, is the whole point. But this Bill removes that ‘duty to provide’; it does away with geographical boundaries, it is no longer the safety net it was. Do we really want that? Do we really want to go back to the days when ability to pay determined our health care. I know I don’t. That is why, this time, I am not laughing and shrugging. I am speaking out, and trying to get this stopped. Please help.

God Bless the Royal College of Radiologists

God Bless the Royal College of Radiologists!

I was moping at my computer, depressed by the apparent lack of response to the Faculty EGM and wondering what on earth we could all do to start making people realise just how toxic and dangerous the Health and Social Care Bill is when a message dropped into my inbox. A message of such overwhelming importance and encouragement that this blog virtually wrote itself! The news is that the Royal College of Radiologists, alone and so far unsupported, has come out in outright opposition to the Bill. Where the rest of the Academy of Medical Royal Colleges have caved in to the pressure apparently brought upon them by the Secretary of State and the Department of Health, the RCR has stood tall and said ‘we will not be cowed – this is too important’. You can read their statement at http://www.rcr.ac.uk/docs/general/other/RCR_Special_eBulletin_Health_Bill_270112.html

Read it. Publicise it. Understand it. It says all that you need to know about this pernicious Bill, what it will do to the NHS and to the health of the people of this country. It is measured and evidence based and I applaud it. That is why, today, my blog is so short. There is no more for me to say. Except

GOD BLESS THE ROYAL COLLEGE OF RADIOLOGISTS.

Today I said Goodbye to my Brother

That sounds so dramatic, doesn’t it? No, dear readers, he is not gone from this earth, just from this country. And I am sad. Next week, he and his wife emigrate to Canada. They are excited and nervous in almost equal measure. They have a new home, a new life, a new continent. I am happy for them, but the West coast of Canada is a long way away. No longer will I be able to ring them whenever I feel like it – I shall have to calculate carefully to make sure that I am not ringing in the middle of the night. No longer can I pop down for the weekend, or meet up for lunch in a mutually agreed place half way between our homes. No longer can I ring him when my computer plays up and hope that he will sort it out for me – what seemed semi-reasonable when he was 200 miles away seems completely unreasonable from thousands of miles away.

But the sadness goes far deeper than that. Many years ago, we both moved country, looking for a better life and a better education. Then, I am not sure that either of us believed that it was permanent. We went through the upheaval, the difficulties of building a new life, making new friends, understanding a new, if familiar, culture. Since then, he and his wife have roamed across Europe, where the job and their instincts have taken them, and I have watched and marvelled as my baby brother became a success, far overtook my own poor efforts. I am immensely proud of him.

And now they are turning their backs on the old continent, disillusioned by the lack of enterprise, by the ridiculous political correctness, by the way that all service seems to be grudging and nobody seems to care. Today, as we sat at lunch sharing a last meal and a last bottle of wine, he told me about the car salesman who has agreed to release their new car after only a credit card deposit and an uncleared cheque to be handed over on the day. He told me of the television engineer who is coming in to work early on the day after they arrive, because it is more convenient for them, even though they have never met.  He told me of the estate agent who, when the purchase on their new house completed, left a small gift in the house.

I look forward to getting to know their new home. I shall greatly enjoy getting to know a new place and beginning to understand a new culture. I look forward to all the opportunities that will open up for them. But I am sad that they have to go so far to attain this. Sad that this once great country can no longer provide these things. Where did we go so wrong?

Je Regrette

Today, I attended the Extraordinary General Meeting of the Faculty of Public Health. This was, indeed, an ‘extraordinary’ event. We Public Health folks tend to be passionate about public health, but well used to negotiating and trying to persuade, rather than outright opposition and major fights. We know that we do not have much power, but we encourage, cajole, influence, present the evidence and, often, finally win through. We are passionate about our populations, about what they need and what should be provided for them. We try to put them first.

We also, in the main, support our Faculty. We know that they do a good job under difficult circumstances. They are not paid. They do it on top of the day job, or after they retire. They are honourable, caring and, in these difficult times, they are doing the best they can.

Yet today, for the first time in 30 years, we had an EGM. Today, the rank and file of the Faculty called upon the Board to take a different stance. Today, we demanded that the Board changed its policy of attempting to influence amendments to the Health and Social Care Bill, and come out in outright opposition to it.

About 6% of the 3500 Faculty members travelled to Birmingham to take part in the debate. This sounds tiny. It is not. It is huge. Remember, the Faculty has large numbers of overseas members, members from Scotland, Wales and Northern Ireland who are less immediately affected, retired members, sick members, old members. This was a working day – many were unable to get the time off because of pre-existing commitments they thought too important to abandon. There were others who watched the live stream but were unable to vote. This was a large turnout of concerned people. There were past Presidents, distinguished academics, registrars just starting out in careers in public health, and those, like me, who are just jobbing public health professionals. We had all made our way to Birmingham because we thought this too important to miss; because we care deeply and wanted to make our voices heard.

The debate was robust but professional, as it should be in such a company. The President distinguished herself with her calm bearing and non-partisan chairing. She faced all challenges with a remarkable calm and made a series of correct decisions. There were some outstanding presentations, and others that left a lot to be desired, but on the whole it was an edifying spectacle of a group of people facing up to one of the most difficult dilemmas that they are ever likely to confront. Everybody knew that there was no cut and dried ‘right answer’. This was a judgment call, and we had to make it. Although the vote is not binding on the Faculty Board, a clear message would be bound to carry weight.

In the end, the vote to move to outright opposition to the Bill was overwhelming. There could be no doubt that the mood of those in the room was to oppose the Bill as a danger to the health of the people of this country and a move to privatise and destroy the NHS. I was pleased and relieved that the vote was so clear. Nobody could claim that the room was split.

So what is there to regret? I regret that it came to this – that we could not have achieved this result by consensus. I regret that it has caused divisions in the public health family and, for some, left a feeling of anger. I regret that, because of the poorly worded motion in support of the Faculty, I did not feel able to support it. I regret that we have been placed in this position by an intransigent Secretary of State who does not know the meaning of the verb ‘to listen’ and who insists on riding rough shod over all the voices, medical, nursing and others, telling him that this will not work.

But, I do NOT regret going to Birmingham. I do NOT regret speaking out, even if that puts me in bad odour with some people. I do NOT regret the company I found myself in, particularly those with far more to lose than I. Most of all, I do NOT regret that I have struck a blow, no matter how small, for the NHS and the health of the people of this country. I do not believe that this will be a day I shall regret on my deathbed.

Save the NHS: Public Health

Public Health, the discipline, is under threat. Why do I say this? And does it matter? Well, I say this because it is being fragmented and bowdlerised. And, yes, I think it does matter. Read on, if you are interested.

The dismemberment of public health is less immediately threatening than other things that are happening to the NHS, but I would contend that it would have really bad consequences for the health of the public in England. Public Health is concerned with health promotion (looking at healthy lifestyles etc), health protection (epidemics, infectious diseases, screening etc) and the commissioning of health services.

If the plans go ahead, health promotion will be in Local Authorities, health protection will be split between them and Public Health England (PHE) and the commissioning will be wherever anybody bothers to remember it. In other words, despite what we are constantly told, there will be no coherent PH service. PHE is supposed to provide this, but in reality it only provides the equivalent of the present Health Protection Agency (HPA) plus some rather random bits of general PH. This is not coherent policy - it is a disaster waiting to happen as nobody has control or accountability for health protection at a local level. When we had the flu scare, it was not the HPA that organised the local distribution of vaccine, nor of talking to the public. That was PH in the PCT - which will be abolished. Who will do it next time?

Equally dangerous, the parts of PH that currently do the commissioning of NHS services are being ignored or disbanded. We are told that PH 'advice' will be given to Clinical Commissioning Groups (CCGs) from the LA. But 'advice' is not the point. We in PH actually do the work, make the decisions, talk to clinicians and patients, make ourselves unpopular and end up in the press. Who will do that now? Where will that be based? It certainly will not be at the National Commissioning Board, because we have been told that PH is not wanted there. CCGs will not have extra money to buy public health services. Some will be provided from the local authorities to CCGs, but this will be at the discretion of the local authority department, and subject to other demands. We are told that the GPs will do it - but they already have full-time jobs and they do not have the training in population medicine that PH people do.

And did you know (or does Mr Landsley know) that every time a GP comes to a meeting we have to pay locum costs? You don't pay for PH advice over and above the salary. But you do for GPs. Think about it.

Saving the NHS

The health and social care bill is making its stormy passage through the houses of parliament. It is big and complicated, and it has been much misunderstood and inadequately covered in the media. But this bill is a major threat to the health of the public in England and should be seen as such.

The health of the public is under threat because:

• The secretary of state will no longer have a duty to provide services. This will be delegated to the scores of clinical commissioning groups which are being set up. These CCGs will not have clearly defined populations. Unlike the Primary Care Trusts (PCTs), which have a responsibility for each person within their boundaries, this will not be clearly defined. So what happens to the homeless? To those not registered with a GP? And how do we monitor outcomes, and what is really happening, if we do not know how many people we are supposed to be looking after?

• As each CCG will be able to decide for itself what services it will provide, including services for pregnant women and children, there could be very different decisions made for very similar patients. We are told that this already happens with PCTs, and it does. The difference is, that CCGs will be much smaller, and there will be many more of them, so the postcode lottery will get much worse (my own PCT is breaking into five CCGs). We are told that they will gradually amalgamate – to make PCTs again?

No, because the GPs will be in the driving seat, we are told, and they know what is best for their patients. Fair enough, but will they really commission? They already have full time jobs. Recent documents have made clear that most commissioning will be done by private companies or by social enterprises. Why not just put GPs into the driving seat in PCTs? So much easier. Job done.

• The pregnant women, breast-feeding mothers and children are also important. Without going into lots of legal explanations, the changes proposed would make it possible for CCGs to charge for these services. Of course, they won't. But, then, why make it possible for them to do so? And cut the amount of money they have to organise the services? Why leave something this important to the good will of a cash-strapped CCG?

• There is no mention of ambulance and accident services in the Bill. Possibly they forgot?!

In short, this bill is a danger to the health of the public and should be seen as such. It will lead to increased health inequalities, poorer services for patients and the fragmentation of public health services. If it is passed, the NHS will be no more than a brand name – but that's a story for another day.