21 May 2011

The devastating power of words

Everybody now knows that there is widespread disquiet over Lansley's Bill. There is no argument about that. And it is becoming increasingly clear that Mr Cameron's pause and listen is really just a political ploy to enable what will essentially amount to the original bill being railroaded through parliament much as was originally intended.

What was originally intended? The answer is in the draft Conservative Manifesto published in 2010. Here it states:

With less political interference in the NHS, we will turn the Department of Health into a Department of Public Health so that the prevention of illness gets the attention from government it needs.

Just one sentence. Innocuous enough you might think. When Grumble read this he thought this was a cosmetic name change. Governments like to change the names of things. It gives the illusion of progress when in fact all that has happened is that the label over the departmental portico has been repainted. But when it comes to the health service the real intent is not always spelt out. It is not just the Conservative party that has been calculatedly vague: New Labour were masters of obfuscation. Read that paragraph carefully and extrapolate and all is revealed.

You see Public Health is actually only a very small part of health. About 3% in fact. It is important but it is hardly what most people would call healthcare. It is about preventing the spread of infectious diseases and the like. It is something that government has to be involved in because these things cannot be dealt with just at a local level. There has to be an input from national government. It is not a duty you can palm off on others.

OK so far? The next bit is where you have to read between the lines. If the Department of Health is going to do Public Health which will have "the attention from government it needs" what happens to everything else the Department of Health (and government) used to have a responsibility for? The answer, if Grumble's interpretation is correct, is that these other things do not need the attention of government. That is essentially the meaning of "less political interference in the NHS". It is a euphemism for government abandoning the NHS to its own devices. OK. Dr Grumble is sensitive to how his sceptical readers may be thinking. This could be an extrapolation too far.

So let's now take a look at the new Bill. But before we do we need to know where we start from. Here is a key responsibility for the Secretary of State as laid down in the National Health Service Act 2006.

National Health Service Act 2006

1 Secretary of State's duty to promote health service

(1) The Secretary of State must continue the promotion in England of a comprehensive health service designed to secure improvement—

(a) in the physical and mental health of the people of England, and

(b) in the prevention, diagnosis and treatment of illness.

(2) The Secretary of State must for that purpose provide or secure the provision of services in accordance with this Act.

Take a look at (2). Here you see a clear statement that the Secretary of State has to provide or secure the provision of services to prevent, diagnose and treat physical and mental illnesses amongst the people of England. That anyway is Grumble's interpretation of the words of the law. Grumble could be wrong. He is not a lawyer but that is how the law seems to read. To be frank, it is a pretty tall order. Our government has to provide for the health needs of each and every one of us. It is a very British thing. Electing governments to look after our health is something we in England do. It is something the electorate wants and expects. It is one of the things we have governments for. They need to defend the realm and look after us, including our healthcare. It has been like that for more than 60 years. And we want it to stay that way.

Of course this is an enormous responsibility for a government so it is no surprise that all the major political parties want to be rid of this commitment. Just as they do not want to run the railways, schools or universities or, well, anything. Today's citizen must stand up on his own two feet and look after himself. It is inconvenient for the old Etonians in charge that the public might actually expect them to provide some infrastructure for the country like decent roads and a rail network and schooling for our children and universities. But there it is. We do. And we are not impressed that students with no money have to pay for their own education. We are not at all impressed. It might be OK for your children, Mr Cameron. It might even be OK for Grumble's children but it is hardly fair on the children from the council estate.

Grumble is digressing somewhat but you can see there is a theme here. And the theme extends to the NHS. Because they don't want to provide that any more either. Who do they expect to do that? Well, it's your GP isn't it? You might think your GP was busy enough seeing patients. And you might well be right but he now has to run the NHS as well - instead of the Secretary of State.

Now we come to the important bit because Grumble has, up to now, been speculating. It could be that things aren't really quite this bad. So let's now take a look at the Mr Lansley's Bill. Is there anything in the new words of the law that gives credence to Grumble's eccentric suspicions? Here is the relevant bit :

The Lansley Bill

Secretary of State's duty to promote health service

(1) The Secretary of State must continue the promotion in England of a comprehensive health service designed to secure improvement—

(a) in the physical and mental health of the people of England, and

(b) in the prevention, diagnosis and treatment of illness.

In other words, whereas previously the Secretary of State had to "provide or secure the provision of services" he now only has to "promote a comprehensive health service".

Please forgive Dr Grumble if he has got this wrong. Grumble has no legal training. The law is perplexing but Grumble can read and it looks very much as if Lansley is largely washing his hands of any responsibility for having to provide healthcare to us all. This is a momentous change. It is one that those of us who do not have the time to trawl through the legal gobbledegook may have missed. These words are crucial. For the NHS they are devastating.


Grumble was made aware of this drastic change by Dr No. Richard Blogger has also contributed to Grumble's understanding as well as the Witch Doctor who has also heightened Grumble's concern over this crucial element of an insidious bill. Dr Grumble thanks them all.


Dr No said...

Too right, and thanks for promulgating this. Dr No sees this change in the SoS's duty from a duty to provide to a duty to promote as the crucial change. It's a bit like taking the captain off the bridge of a supertanker and then wondering why it hit the rocks...

And in the health service, once the SoS (and so the government) no longer has a duty to provide a health service - well - anything goes...

Northern Doctor said...

I think the subtle rephrasing here of the duties of the SoS does represent an important shift.

However, it's not exactly a secret that Lansley would be happy to see a much wider variety of providers with less direct state responsibility to provide the actual services - and that's exactly what this Bill is all about.

The dismissal of public health as being 'about the spread of infectious diseases and the like' is spectacularly inaccurate. And the suggestion that more emphasis on public health is a euphemism for abandoning other services is certainly an 'extrapolation too far' for this sceptic.

GP commissioning would be run by consortia and GPs aren't going to get dragged out of clinics - the GPs interested in running this are already doing it with PCTs. And I could have lived without the tired old leftie rant in the middle but it's your blog and your perogative.

I'm no supporter of this Bill and I'd cheerfully see it torched but dressing it up in all this flannel won't help the case.

Dr No said...

The wording is subtle, but the effect seismic.

The PHM thing is a red herring/smoke screen. Public Health doctors in the UK are a collection of misfits, duds and fireworks that didn't go off. Liar Liar Pants-on-Fiar Donaldson is perhaps the best know recent example.

We can do without PH for now. Yes Dr No knows they don't only count cases of food poisoning. But what is at stake at the moment is the health service.

britishmedicaljobs said...

The government seems hell bent on railroading it's views on us and not just on the NHS. But are we to blame for voting them into power?

Cockroach Catcher said...

We are in The Guardian.

The Cockroach Catcher

Cockroach Catcher said...

Thanks for the mentions in Shared Items.