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.