11 June 2011

Radical policies for which no one has voted

If a government is pursuing radical policies for which no one has voted what can you do? Not much really. Writing to your MP is worth a try. It might be more worthwhile if your MP happens to be in the cabinet.

A friend, briefed by Dr Grumble, sent this letter to his MP, a well-known cabinet minister:

Dear Cabinet Minister,

Health and Social Care Bill 2011

I am writing to express my concern about the general direction of the proposed NHS reforms. We have been repeatedly told that the NHS has to change. The evidence for this assertion is lacking. We do have a problem: health-care spending is predicted to rise because of the increasing numbers of elderly and the ever-increasing costs of treatment. That is the problem, not the current structure of the NHS.

The Commonwealth Fund has found the NHS to be the most cost-efficient healthcare service in the world. The World Health Organisation recognises the French system as being the best in the world but the French spend 11.2% of GDP on health care compared with our 8.6%. Despite this, our figures are improving much more rapidly than those in France.

I am particularly concerned about the move towards privatisation and a more American-style system. In the United States spending on health care in the year 2005 was £3921 per person whereas the figure for the NHS was £1603. Are their results any better? No. The British have generally better health and live a year longer. And the cost of administration of the US system is three times that of the NHS.

Why can we not accept that rationing is a fact of life in all health care systems. We need to ration on the basis of need. The National Institute of Clinical Excellence has led the way on this, is admired throughout the world and has ensured that we provide the best treatments to the greatest number of people.

We all accept that there is a need to keep healthcare spending under control but allowing the NHS to fragment into a loose association of multiple providers all in competition with each other is hardly the route to cost-effective integrated health care. I do hope you will do what you can to ensure that the Bill is shelved.

Yours sincerely,

A Grumblefriend

The reply he received is as follows:

Dear Mr Grumblefriend,

Thank you for your letter. Our plans to modernise the NHS have a simple aim: to ensure everyone is provided with healthcare - free at the point of use - which is the best in the world. At the moment, and despite years of extra investment productivity has declined by 15 per cent over the previous 10 years. We have to modernise the NHS to ensure that it is ready to meet the twin pressures of an ageing population and rapid advances in medicine.

We have already made several changes in response to concerns voiced by healthcare professionals - this includes strengthening the provision that competition will be based on quality not price. I can also assure you that the Secretary of State will still have a duty to promote a comprehensive health service. Now that the Bill has passed through the Commons there is a natural pause before it is considered by the Lords. We will be using this break to listen to the concerns that people still have. Where those concerns are genuine we will engage with those who want the NHS to succeed and make amendments to improve the Bill.

Yours sincerely,

A Cabinet Minister

The cabinet minister signs off with just his first name. Grumble's friend moves in high circles. The letter is clearly a standard reply. It even mentions a major concern that Grumble's friend neglected to raise: the crucial change in the responsibility of the Secretary of State who now only has a duty 'to promote' a comprehensive health service. Plainly it is not just a few maverick medical bloggers who have spotted this fundamental change to the law.

This bland mollifying reply, sent doubtless to numerous constituents, actually reveals that they are not going to budge one iota on this crucial point. No longer will the law state that the Secretary of State
"must...provide or secure the provision of [National Health] services.."
The duty to provide comprehensive health care has gone. The requirement that previous benevolent governments took upon themselves at times of great hardship to provide healthcare for us all, rich and poor, has been taken away. It has gone forever.

‘The NHS will last as long as there are folk left with the faith to fight for it.’
Aneurin Bevan

Are there still enough folk out there with the faith to fight? Possibly not. Not in parliament anyway. People are afraid. Very afraid. And they are right to be.


Witch Doctor said...

Sometimes I wonder why it is considered necessary for a new law regarding the NHS. After all, many of the changes such as commodification of healthcare, competitive tendering for clinical services, and dumbing down in an attempt to cheapen the costs of labour have been going on for some years now.

So, why now?

The conclusion I am coming to is that there are two reasons.

1. The abdication of the government's ultimate responsibility for healthcare as was slipped in almost un-noticed into the HSCB.

2. The planned privatisation of clinical services would quickly become so extensive that the government would require the law to protect them when the people of the country woke up to what was really happening to their healthcare system.

My Black Cat thinks it is a great big conspiracy, but we witches think it's because successive governments are scared stiff about the threats that they and their advisors perceive are associated with demographic change and the balance of power worldwide.

Dr Grumble said...

Yes, WD. I have had similar thoughts

They plainly intended the abdication of the government's responsibility to provide healthcare to be slipped in unnoticed.

This would then have enabled them to distance themselves from what, up until now, has been the responsibility of government: the provision of healthcare to the people of England.

The fall guys taking the responsibility for the new doomed service were intended to be the GPs - the most trusted people in the land. Having control of the money and a suspicion of hospitals they would see that the dwindling resources were directed towards the community – which the management consultants think will lead to savings.

The completely unwritten element of the plan was to wind down spending (and inevitably quantity and/or quality of care) forcing the better off to provide for themselves thus bringing more money into healthcare and a booming private healthcare sector – but, unfortunately, much less efficiency and, certainly, much more care according to wants rather than needs.

The most efficient healthcare system in the world would be a thing of the past.

Having been rumbled, the government has been forced to do some tweaking but the intent remains the same.

Successive governments have tried to distance themselves from the NHS using various methods - all of which failed. I don't think there is anything particularly ConDem about that as a political approach. But there is much to be condemned.

Anonymous said...

Blame the BBC and the rest of the pro government media for the majority of the public being unaware of plan to remove our universal healthcare
Thanks to medical bloggers like WD and Dr Grumble , the campaign at http://www.38degrees.org.uk/pages/save_our_nhs_action_centre
is spreading the message.
I pray it's not to late

Anonymouse said...


I think the government is fully aware of the depth of feelings re the NHS bill amongst the public Dr G.

But it's not just the public who have these feelings, William Hague called it "a reform too far" ... and the favourite who was lined up to grab Lansley's place now doesn't want to know either! ... after an initial enthusiasm


Anonymouse said...

Sorry ... meant to say government Not fully aware

Dr Grumble said...

Even Norman Tebbit has expressed his concerns. He said: “The only member of my family to get private sector medicine is the dog.” Just like the Grumble family.


Anonymouse said...

“The only member of my family to get private sector medicine is the dog.”

Sensible man!

I like Lord Tibbet, but I wouldn't worry too much about him Dr G cos I'm sure his Lordship can afford to give himself the same treatment as his dog, 'if' he so wishes. Perhaps he should too!

We're talking about 'the vulnerable' here, and what worries all of us is that perhaps those won't get half that dog's dinner, or treatment, in the near future.

So, read a bit between the lines in that link I gave you before. This bit here, for example;

"Stephen Dorrell (Con, Charnwood) said Mr Lansley remained 'the best man for the job'.

Mr Dorrell, health secretary under John Major from 1995 to 1997, denied the NHS reforms had been poorly managed and said [it was unlikely the government would bow to pressure to withdraw the Bill.]

I think the bit I put between brackets is why he doesn't want to know anymore. Maybe because if he was to accept the job, he would've done away with the bill himself, as maybe he thinks the job can't be done at all otherwise - and why the "I'm off and let's watch Lansley do it"

The rest is over to you, but it must very hard to walk away from a cabinet post - and a place in history as twice in the cabinet and under 2 different PMs too Dr G - very hard! :)

Dr No said...

The maverick medical blogger also considers fear to be a primary driver for the reforms.

All the parties imagine a huge NHS financial train crash coming, and all the parties want to dump the NHS off the government books before their imagined train crash happens. They are all frightened - and fear is a very powerful driver.

The maverick medical blogger has in fact posted on this (Hostle Intent) and suggested that what we should be doing is focusing as much on (and defusing) this underlying but very powerful fear as much as on the other unsavoury aspects of the reforms.

Anonymouse said...


I think the public would use 'make believe' in place of 'imagine' Dr No, or those are the vibes I get when I talk with friends and neighbours. Because most people can't understand why the NHS is heading for "a financial train crash" at a time when all their taxes is going towards paying the bankers huge bonuses after having to bail them after they messed up big time out too. From what I hear, there are still very hot feelings towards the bankers out there and it doesn't cool anyone down to tell the people that the banks are allowed to do what they like because otherwise they would up and go. Too true too, get the 20 billion from the banks and leave the NHS alone - and let those who can 'comfortablly' afford it go private too - so that you can afford a decent service, and not one from the back of a lorry, for those who need it; ie, the hard working middle income and the poor. Fair

Dr No said...

Too right Anonymouse. Strange isn't it how the banks get bailed out but the NHS is deemed a failure that has to be reformed.

Dr Grumble said...

Notice how the cabinet minister's reply begins with doing down the productivity of the NHS. It used to be cancer figures or heart attacks in France but they feel vulnerable on those so they focus on something unmeasurable: productivity. Never do they say that the NHS is the most cost-effective in the world.

As Dr No says, for our government the NHS is a failure not deserving of taxpayer's money and the banks a success that need to be baled out from time to time despite the billions they stash away for themeselves. The NHS has to be changed because it is a basket case and the banks are left to carry on as before because they do not have a problem.

Anonymouse said...

"The NHS has to be changed because it is a basket case and the banks are left to carry on as before because they do not have a problem"

Only without health, you have no economy Dr G and back to the middle ages, the reason why people are so passionate about it. The NHS protects their health and their livilihoods. Nothing can match that

Dr Aust said...

Though irrelevant to the greater issues at hand, Dr G, did you enjoy the video of the classic consultant orthopod getting cross and tossing Dave 'n' Nick's camera crew out of the ward?

Dr Grumble said...

What do you think he was cross about? Was it really infection control? Orthopaedic surgeons can take that very seriously and I think he had both bow tie and short-sleeved shirt. Or was it the politicians' circus appearing on his ward.

How many times have we seen Cameron now in some tame hospital or other? He doesn't have to go anywhere near a hospital to do his job. Reminds me of Blair. If you do too much of this talking to patients thing, people will rumble what it is all about.

Anonymous said...

DR Zorro has rumbled it:


Anonymouse said...

"What do you think he was cross about? Was it really infection control? "

Visitors are not obliged to roll sleeves or remove tie, so why not consider the journalists and crew as visitors? GPs don't do it either! So no, I think that surgeon was trying to point out the opposite; that infection control has gone berzerk with that forced imposition of bow/no tie and half sleeve on hospital docs. If so, I agree with him, but not with the way to do it - too rough.

Bring back the white coat, me says :-)