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.
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.
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.