A postcard for the NHS

Clare Gerada's speech to the RCGP conference

"Like blood, health care is too precious, intimate and corruptible to entrust to the market"

Woolhandler & Himmelstein "When Money is the Mission –The High Cost of Investor-Owned Care," New England Journal of Medicine. 1999

The full text of the speech in case you prefer to read it (and it is quicker to read) is below.







Thank you for all your support over the last year.

I’d like to tell you a story about a GP, a radiologist, a pathologist and a psychiatrist.

Sounds like the first line of a joke, but it isn’t.

The GP was me.

We were having dinner with our children at an open-air opera in Germany. The place was packed.

Everyone was having a good time – when the dreaded happened.

Out of the corner of my eye, I saw an elderly man fall headfirst into his plate.

The four of us looked at each other.

We knew our meal was over – and we swung into action.

Each working to type.

The psychiatrist tending to the man’s wife.

The radiologist searching for a defibrillator.

The pathologist pounding on the poor man’s chest.

Me giving mouth-to-mouth.

From the way he keeled over, it was obvious he was dead.

But we knew there was still plenty for us to do.

We had to comfort his distressed wife.

And we had to keep the crowd calm for 30 minutes, till the paramedics arrived.

When it was over my 15-year-old son turned to me and said,

"I want to be able to do that."

"Do what?" I asked him.

"Care for people", he said.

His reply surprised me.

Not just because impressing teenage children isn’t easy.

But because what impressed him wasn’t the glory and the drama of our public display of medical skill.

No. What impressed him was our simple act of caring.

Caring for a sick man. Caring for the man’s wife.

And caring for the people in the crowd.

That’s what inspired my son.

And that’s how my father inspired me a generation ago.

It wouldn’t be allowed now, but he used to take me with him on home visits in the post-war slums of Peterborough.

I watched him treat children with measles.

And care for the dying in their homes.

That’s when I knew I wanted to be a doctor.

Why did I tell you that story?

Because I believe each of us has a story about what inspired us to become a doctor.

A story that made us what we are today.

A story that lights our way to the future.

What’s yours?

Our stories have never been more important.

Especially now, when our profession is under pressure to replace the language of caring with the language of the market.

This is why I told you my story.

We need to remind ourselves why we entered this honourable profession in the first place.

When I come home from work and my son asks me what sort of day I’ve had, on a good day I want to be able to say ‘I saved a life’, not… ‘I met a budget’.

Of course, it’s important that GPs are mindful of resources.

We have a responsibility to spend the public’s money carefully – and wisely. That goes without saying.

But we must never lose sight of the patient as a person, at the heart of our practice. Patients are not "commodities" to be bought and sold in the health marketplace.

In this brave new cost-driven

Competitive

managed-care world,

I worry about the effect the language of marketing is having on our clinical relationships.

It’s changing the precious relationship between clinician and patient into a crudely costed financial procedure.

Turning our patients into aliquots of costed tariffs.

And us into financial managers of care.

We are already embracing the language of the market when we talk about: for example

Care pathways
Case management
Demand management
Productivity
Clinical and financial alignment
Risk stratification
We’re already accused of making "inappropriate referrals" whenever we put what’s best for our patients above what’s best for saving money.

We’re being forced to comply with referral protocols and so-called rules-based medicine, in an effort to control medical care before it’s delivered.

Referral management systems – already widespread – places a hidden stranger in the consulting room.

A hidden stranger who interferes with decisions that should be made by GPs in partnership with their patients.

Insulting terms, like "frequent flyers", are being used to describe people who are sick and need our care and attention.

The Archbishop of Canterbury attacked what he described as "the quiet resurgence of the seductive language of the deserving and undeserving poor".

If we don’t watch out, the deserving and undeserving poor could soon be joined by the deserving and undeserving sick.

I worry we’re heading towards a situation where healthcare will be like a budget airline.

There’ll be two queues. One queue for those who can afford to pay, and another for those who can’t.

Seats will be limited to those who muscle in first.

And the rest will be left stranded on the tarmac.

This can’t be right. After all, no one chooses to be sick. <

We must hold fast to the principle that good healthcare should be available to all, regardless of wealth.

Of course, there have always been health inequalities. But my concern is that despite all the talk of reducing these inequalities, the size looks set to increase, not decrease.

So what about GP commissioning?

Will it help us reduce health inequalities?

And will it enable us to deliver better care to our patients?

People often tell me that GPs make good commissioners because of the population-focus we bring to care.

After all as a profession we see 300 million patients per year.

If anyone can be said to have their finger on the pulse of the nation, surely it’s us.

It’s an argument I’ve supported for decades.

But we must tread carefully in this brave new world.

And do everything in our power to make sure it’s the public’s pulse we have our fingers on… not the public’s purse!

Which is why I believe that big decisions – decisions like whether to close hospitals – should be the responsibility of governments, not GPs.

It’s the government’s job to decide how much we invest in healthcare – and what services the NHS should provide.

Of course we should do our bit – we already do, by sitting on NICE, SIGN and other committees.

But governments should have ultimate responsibility for decisions about rationing healthcare, not GPs – guided and advised by us, for sure, but finally the decision must be taken by a publically accountable body, not an individual doctor or a group of doctors

We don’t shirk our responsibilities.

Governments shouldn’t shirk theirs either.

Rhetoric about putting doctors in charge doesn’t convince me.

In this brave new world it’s the market – led by CEOs, share-holders and accountants – that will be in charge, not doctors.

We mustn’t allow ourselves to be compromised.

Our first responsibility must be to the patient in front of us.

Our next is to the patients in the waiting room.

After that comes our responsibility to those on our list.

And then to our local community, and finally the wider population.

In that order.

I’ve always said that Good Commissioning is about being a good GP.

Its about understanding how we use resources fairly and effectively.

But whatever happens we must make sure that the commissioning agenda isn’t allowed to compromise our relationship with the patient in front of us.

We must not risk long-term benefits being sacrificed in favour of short-term savings.

How soon will it be, for example, before we stop referring for cochlear implant? -

An expensive intervention, but one that in the long term, saves enormous amounts of public money.

But not a saving from our budget.

How long will it be before we find ourselves injecting a patient’s knee joint – at Injections-R-us plc - instead of referring to an orthopaedic surgeon for a knee replacement?

And, once referred for hospital treatment, patients must be able to trust their doctors to base care on need and not on making money for the hospital.

If you think this is far-fetched…

The Economist calculated that in 2009 the market-driven, corporate-dominated US health care system generated around $300 billion dollars worth of charges for unnecessary care.

This represented 10-12% of US healthcare spending for that year.

• This means women having unnecessary hysterectomies

• This mean men having unnecessary angiograms

• This means adolescents being given antidepressants for no reason

Do we want that here?

As doctors we risk being doubly compromised.

We’ll have to choose between the best interests of our patients and those of the commissioning group’s purse.

And, to make matters worse, we’ll also be rewarded for staying in budget – and not spending the money on restoring that child’s hearing.

It goes by the quaint title of the "quality premium".

Now that’s what I call a perverse incentive.

What will you do when you’re presented with choices like these? Because you will be!

We are told that one of the reasons Clinical Commissioning is being introduced is to reduce the spiralling costs of health care.

But if the American experience is anything to go by, the opposite will be true.

Paul Ellwood one of the founders of the American Health Maintenance System in the 1970s, had this to say in 1999 about what happened there…

"A series of perverse economic incentives were instituted

from top to bottom

so as to seriously compromise the independent clinical judgments of physicians

and other health professionals…..

He describes Health Maintenance Organisations (which have the same function as our Clinical Commissioning Groups) as finding themselves in…

"A deepening swamp of commercialism over service,

of profiteering over professionalism,

of denial or rationing of care where such care is critically needed,

of de-personalization of intensely personal kinds of relationships"

Is this what we want here?

The NHS can always be improved, but we must do it very carefully, so as not to lose what we and previous generations of doctors like my father have achieved.

As Allyson Pollock reminds us, the NHS was not an experiment.

It wasn’t a mythical utopia either.

The reality is that for more than 50 years it has delivered high quality care for most patients, most of the time.

Can the market achieve similar outcomes?

There is plenty of evidence that market driven health services lead to:

• Limited choice
• Escalating costs
• Reduced quality

And let’s remind ourselves – the biggest health market in the world, the US, has achieved the remarkable double whammy of having the most expensive system in the world and the greatest health inequalities.

It comes near the bottom of the league for most health outcomes – and boasts an unnecessary death every 12 minutes.

So what can we do?

It would be easy to feel discouraged.

But I know we all want the best for our patients, we always have and we always will.

And as long as we do what we know to be right for patients, we will keep their trust.

And we can do this by ensuring that the systems we work in continue to allow us to work ethically and always as our patients advocates.

We must resist the encroachments of the market wherever it threatens our freedom to serve our patients and our communities. This is what those of you leading commissioning must promise us.

We have to get the actuaries, risk-adjusters and share-holders out of the health service, and put clinicians (not just medics) back in charge of it.

And then we need to bring in management staff to advise and assist us.
Staff who are truly committed to the values of our NHS.

We all became doctors because we wanted to make a positive difference to people’s lives.

It would be hard to devise a better and more inspiring way of achieving this than through the provision of excellent general practice care, within a universal health service.

In times of austerity, we need to come together so that we can collaborate, cooperate and innovate… not compete against each other.

You expected me to talk about the Health Bill in England, but this Bill, like other reorganisations across the whole of the United Kingdom will come and go.

Instead I have chosen to talk to you about what matters to our patients, now and for ever - a doctor who cares.

I am convinced that there are enough of us to create a revolution in health care. Not a revolution that the Government is talking about in the Bill –in structures, payments and competition.

But a revolution in values.
One that will provide excellent care to our patients.

Where in every interaction we pinch ourselves at the honour we have been given to be privy to their secrets and pain –

and as Don Berwick says:

"being allowed to be guests in their lives"

My message to you is simple and clear. My son wanted to do medicine because of what he saw me and my friends do – care

If we want to keep serving the best interests of our patients, we must reject the language of the market and embrace the language of caring.

And – keep telling our stories…

Thank you.

What to do with Lansley's rotten bill

The Liberal Democrats have let us all down on a grand scale but there are a few around with a great deal of common sense. Charles West is one. Read what he had to say here: pdf. Of course, any doctor with a modicum of nous could have written this. Not many politicians could. But then Charles West is a doctor.

What NHS managers think of the bill

97.1% of managers say withdraw the Health and Social Care Bill (pdf).

Open letter to the Lords

Here is the text of a letter from doctors in England to the Lords:

As doctors in England, we are writing to you to express our conviction that the Health and Social Care Bill will irreparably undermine the most important and admirable principles of the National Health Service, and to appeal for its rejection by the House of Lords.

Because it is universal and comprehensive, and publicly accountable, and because clinical decisions are made without regard for financial gain, the NHS is rightly regarded all over the world as the benchmark for fairness and equity in healthcare provision.

The transfer of services to private, profit-making companies will result in loss of public accountability and a damaging focus instead on low-risk areas that are financially profitable. A confused patchwork of competing providers will deliver a fragmented and inequitable service and any reliance on personal health budgets or insurance policies will further increase inequality. Because there will be a financial incentive for providing treatment patients will be over-treated, the potential costs of which are limitless. And the possibility of the commissioning role being outsourced to the private sector is also deeply concerning.

In forcing through this ill-conceived Bill, without an electoral mandate and against the strident objections of healthcare professionals, the Government is also ignoring overwhelming evidence that healthcare markets are inefficient and expensive to administer.

The public has been misled throughout, first by claims that no major reorganisation of the NHS would be undertaken, later by repeated denials that what is happening represents privatisation, and furthermore by suggestions that the Bill enjoys the support of the medical profession. We do not accept the argument that "things have already gone too far" - the enactment of some of the Bill's proposals has been premature and illegal, however some of its most damaging aspects may still be mitigated.

We believe that on moral, clinical and economic grounds, the Health and Social Care Bill must be rejected.

If you are a doctor in England and would like to put your name to this letter please email Jonathan.folb@nhs.net with your details. Feel free to circulate this letter further. Time is now very short. Do it now.

Lords save us

Here is the text of an open letter to the Lords from nearly 400 doctors:

Dear Honourable Members of the House of Lords,

As public health doctors and specialists from within the NHS, academia and elsewhere, we write to express our concerns about the Health and Social Care Bill.

The Bill will do irreparable harm to the NHS, to individual patients and to society as a whole.

It ushers in a significantly heightened degree of commercialisation and marketisation that will fragment patient care; aggravate risks to individual patient safety; erode medical ethics and trust within the health system; widen health inequalities; waste much money on attempts to regulate and manage competition; and undermine the ability of the health system to respond effectively and efficiently to communicable disease outbreaks and other public health emergencies.

While we welcome the emphasis placed on establishing a closer working relationship between public health and local government, the proposed reforms as a whole will disrupt, fragment and weaken the country’s public health capabilities.

The government claims that the reforms have the backing of the health professions. They do not. Neither do they have the general support of the public.

It is our professional judgement that the Health and Social Care Bill will erode the NHS’s ethical and cooperative foundations and that it will not deliver efficiency, quality, fairness or choice.

We therefore request that you reject passage of the Health and Social Care Bill.



Jo Abbott
Consultant in Public Health, NHS Rotherham

Dr Sushma Acquilla
International Faculty Advisor, UK Faculty of Public Health and Honorary Senior Lecturer, Imperial College London

Dr John Acres
Head of the School of Public Health, Wessex Deanery

Dr Mayada Abu Affan
Consultant in Public Health Medicine, Dudley PCT

Dr Nicholas Aigbogun
Specialty Registrar in Public Health, Health Protection Agency West Midlands

Professor Priscilla Alderson
Professor Emerita of Childhood Studies, Institute of Education, University of London

Dr Rob Aldridge
Academic Clinical Fellow (Public Health), University College London

Dr Kirsty Alexander
Public Health Directorate, Gloucestershire PCT

Martin Allaby
NHS Consultant in Public Health

Ben Anderson MPH, MFPH
Acting Consultant in Public Health, NHS Sheffield

Dr Elspeth Anwar
Public Health Registrar, Mersey Deanery

Dr Ike Anya
Consultant in Public Health Medicine

Charlotte Ashton
Public Health Specialty Registrar in London

Professor John R Ashton, CBE
Director of Public Health, Cumbria

Matthew Ashton
Assistant Director of Public Health, NHS Knowsley

Dr Esther Aspinall
Specialist Registrar in Public Health, West of Scotland

Dr Daphne Austin
Chair of the UK Commissioning Public Health Network

Dr Ishraga Awad
Consultant in Public Health Medicine

Dr Sallie Bacon
Associate Director of Public Health, Hampshire

Dr M R Bahl
Consultant in Public Health & Communicable Disease Control (retired)

Dr Simon Balmer
Consultant in Public Health Medicine

Dr Helen Barratt
Research Training Fellow/ Public Health Specialist Registrar, University College London

Prof Mel Bartley
Director of the ESRC International Centre for Life Course Studies, University College London

Dr Subhashis Basu
Specialist Registrar in Public Health and Accident & Emergency, NHS Rotherham and Sheffield Teaching Hospitals

Alison Bell
Consultant in Public Health, NHS Wiltshire

Dr Paul Batchelor
Consultant in Dental Public Health, Thames Valley and Senior Lecturer, UCL

Dr John Battersby
Medical Director, Eastern Region Public Health Observatory

Jackie Beavington
Associate Director of Public Health

Dr Charles R Beck
Specialty Registrar in Public Health

Jane Beenstock
Specialty Registrar, NHS County Durham and NHS Darlington

Dr Ruth Bell
Clinical Senior Lecturer/Honorary NHS Consultant in Public Health, Newcastle University

Professor Yoav Ben-Shlomo
Professor in Clinical Epidemiology, University of Bristol

Helen Bewsher
Public Health Intelligence Specialist, NHS Kirklees

Dr Sohail Bhatti
Interim Director of Public Health Medicine, NHS East Lancashire

Professor Raj Bhopal CBE
Professor of Public Health, University of Edinburgh

Amy Bird
Specialty Registrar Public Health, London, Kent, Surrey and Sussex

Dr Christopher A Birt
Senior Research Fellow / NHS Public Health Physician, Liverpool

Andrew Boddy
Director (retired), Public Health Research Unit, University of Glasgow

Sarah Bowman
Specialty Registrar Public Health, NHS Tees

Dr Ian Brown
Specialty Registrar in Public Health, NHS Hertfordshire

Dr Claire Bradford
NHS Consultant in Public Health Medicine

Dr Fiona Bragg
Specialty Registrar Public Health

Professor Carol Brayne
Professor of Public Health Medicine, University of Cambridge

Professor John Britton
Professor of Epidemiology, University of Nottingham

Dr Helen Bromley
Division of Public Health and Policy, University of Liverpool

Jilla Burgess-Allen
Specialty Registrar in Public Health, Derbyshire County PCT

Julia Burrows
Consultant in Public Health, NHS Bradford and Airedale

Dr Jenny Bywaters
Senior Public Mental Health Adviser, Department of Health (retired)

Dr Nigel Calvert
Associate Director of Public Health, NHS Cumbria

Dr Corinne Camilleri-Ferrante
Consultant in Public Health Medicine and Head of School of Public Health

Professor Simon Capewell
Professor of Clinical Epidemiology, University of Liverpool

Professor Francesco P Cappuccio
Professor of Cardiovascular Medicine & Epidemiology, Warwick Medical School

Dr Robin Carlisle
Consultant in Public Health, NHS Rotherham,

Dr Marie Casey
Specialty Registrar in Public Health

Dr Jacky Chambers
Director of Public Health, Heart of Birmingham tPCT

Dr Jennifer Champion
Acting Consultant in Public Health, NHS Forth Valley

Dr David Chappel
Assistant Director, North East Public Health Observatory

Hannah Chellaswamy
Deputy Director of Public Health, NHS Sefton & Training Programme Director, Cheshire & Merseyside, NW School of Public Health

Professor Aileen Clarke
Professor of Public Health & Health Services Research, Warwick Medical School

Professor Stephen Clift
Professor of Health Education, Canterbury Christ Church University

Dr RA Coates
Consultant in Public Health Medicine, Southampton City PCT

Prof Michel P Coleman
Professor of Epidemiology and Vital Statistics, London School of Hygiene and Tropical Medicine

Katherine Conlon
Speciality Registrar in Public Health, NHS South Gloucestershire

David Conrad
Specialty Registrar in Public Health, Knowsley PCT

Dr Joanna Copping
NHS Consultant in Public Health Medicine

Dr Gary Cook
Consultant Epidemiologist, Stockport NHS Foundation Trust

Professor Derek Cook
Professor of Epidemiology, St George's, University of London

Dr Emer Coffey
Consultant in Public Health, Liverpool PCT

Ellen Cooper
Public Health Specialist, NHS Stockport

Mary Corcoran
Consultant in Public Health, NHS Nottinghamshire County

Jonathan Cox
Specialty Registrar in Public Health, Norwich Medical School

Maureen Crawford
Director of Public Health, Sunderland Teaching Primary Care Trust/Sunderland City Council

Dr Tricia Cresswell
Consultant in Health Protection, Health Protection Agency/Deputy Medical Director, NHS North East

Dr James R Crick
Specialty Registrar in Public Health, Yorkshire and Humber Deanery

Denis Cronin
Public Health Consultant, NHS Cornwall and Isles of Scilly

Professor Ann Crosland
Professor of Nursing and Public Health Lead, University of Sunderland

Dr Elizabeth Crowe
Specialty Registrar in Public Health, SE Scotland

Dr June Crown, OBE
Former President, United Kingdom Faculty of Public Health

Professor Steven Cummins
Professor of Urban Health & NIHR Senior Fellow, Queen Mary University of London

Sarah Cuthberson
Specialty Registrar in Public Health, South Yorkshire Health Protection Unit

Dr Fiona Day
Consultant in Public Health Medicine, Sheffield PCT

Valerie Delpech
Consultant Epidemiologist Health Protection Agency

Prof Elaine Denny
Professor of Health Sociology, Birmingham City University

Martin Dockrell
Fellow of the Royal Society of Public Health

Dr Hiten Dodhia
NHS Public Health Consultant, Lambeth PCT

Professor Danny Dorling
Professor of Human Geography, University of Sheffield

Dr Flora Douglas
Lecturer in Health Promotion, University of Aberdeen/NHS Grampian

Dr Peter Draper
Freelance health policy analyst

Dr Julian Elston
Consultant in Public Health, Cornwall and Isles of Scilly PCT

Barry Evans
Consultant Epidemiologist

Professor David Evans
Professor in Health Services Research, University of the West of England

Dr Jamie Fagg
Research Associate in Epidemiology and Biostatistics, UCL Institute of Child Health

Andrea Fallon
Consultant in Public Health, NHS Oldham

Dr Tracey Farragher
Senior Research Fellow, Academic Unit of Public Health, University of Leeds

Dr Jill Farrington
Consultant in Public Health Medicine, NHS Calderdale

Greg Fell
Consultant in Public Health, NHS

Natalie Field
Public Health Consultant, South Gloucestershire

Dr Richard Fielding
Professor of Medical Psychology in Public Health, University of Hong Kong

Dr Tim Fielding
Public Health Registrar

Dr Alastair Fischer
Health Economist, National Institute for Health and Clinical Excellence (NICE)

Paul Fisher
Specialty Registrar in Public Health, West Midlands East Health Protection Unit

Dr Julian Flowers
Director, East of England Regional Public Health Observatory

Dr Alison Forrester
Clinical Advisor to NHS North Yorkshire and York

Kirsten Foster
Health Improvement Practitioner Advanced, Kirklees PCT

Dr David Foxcroft
Professor of Community Psychology and Public Health, Oxford Brookes University

Sue Frossell
Consultant in Public Health (Health Protection and Improvement), NHS Milton Keynes

Dr Tom Fryers
Hon. Professor of Public Mental Health, University of Leicester

Dr Alison Furey
Independent Public Health Consultant

John Gabbay
Emeritus Professor, University of Southampton

Dr Linda Garvican
QA Director, Cancer Screening Programmes, NHS South East Coast
Dr Alexander Gatherer
Former Director of Public Health, Oxford

Dr Katie Geary
Consultant in Communicable Disease Control, Health Protection Agency East Midlands

Dr Ivan Gee
Senior Lecturer in Public Health, Liverpool John Moores University

Dr Steve George
Reader in Public Health, University of Southampton

Dr Daniel Gibbons
NIHR Doctoral Research Fellow, School of Public Health, Imperial College London

Professor Ruth Gilbert
Professor of Clinical Epidemiology and Director of the Centre for Evidence-based Child Health, University College London - Institute of Child Health

Professor Anna Gilmore
Professor of Public Health, University of Bath

Dr Suzanne Gilman
Public Health Speciality Registrar, NHS Central Lancashire

Dr Michelle Gillies
Specialist Registrar Public Health and Clinical Lecturer Chronic Disease Epidemiology

Dr Jay Ginn
Visiting Professor, Institute of Gerontology, Kings College London

Professor Michael Goldacre
Professor of Public Health, University of Oxford

Chris Godfrey
Consultant in Public Health, Solihull Primary Care Trust

Sara Godward
Locum Consultant in Public Health

Dr Paula Grey
Joint Director of Public Health, Liverpool PCT/Liverpool City Council

Professor Selena Grey
Professor of Public Health, University of the West of England

Dr Carl Griffin
NHS Consultant in Public Health Medicine

Professor Rod Griffiths CBE
Former President, Faculty of Public Health

Sarah Johnson Griffiths
Consultant in Public Health, NHS Western Cheshire

Professor Sian Griffiths, OBE
Former President of the Faculty of Public Health

Rachael Gosling
Locum Consultant in Public Health, Liverpool Community Health NHS Trust

Dr Hilary Guite
Director Public Health and Well-being, NHS Greenwich

Dr Fay Haffenden
Consultant in Public Health Children & Health Inequalities, NHS Cambridgeshire

Professor Sir Andy Haines
Professor of Public Health and Primary Care, London School of Hygiene and Tropical Medicine

Dr Jennifer Hall
Public Health Specialty Registrar, London

Tom Hall
Specialty Registrar in Public Health

Mr John Hampson
Public Health Specialist, NHS Western Cheshire

Wendy Hannon
Public Health Commissioning Manager, Plymouth PCT

Dr Maggie Harding
NHS Consultant in Public Health (Medicine)

Dr Andrew Harmer
Honorary Lecturer in Public Health, London School of Hygiene and Tropical Medicine

Dr Ruth Harrell
Specialty Registrar in Public Health, West Midlands

Lynda Harris
Director of Public Health, Wales

Dr Shamil Haroon
Public Health Registrar, Sandwell PCT

Professor Stephen Harrison
Honorary Professor of Social Policy, University of Manchester

Dr Wayne Harrison
Consultant in Public Health

Martin Hawkings
Consultant in Public Health Medicine, NHS North Yorkshire and York

Hazel Henderson
Consultant in Public Health

Alan Higgins
Director of Public Health, Oldham

Dr Christine Hill
Consultant in Public Health Medicine, Cambridge

Dr Christine E Hine
Head of School & Training Programme Director, SW Public Health Specialty Training Programme and Consultant in Public Health, NHS Bristol & NHS S Gloucs

Julie Hirst
Public Health Specialist, NHS Derbyshire County

Dr Sue Hogarth
Public Health Specialty Registrar, University College London

Dr Jason Horsley
Specialty Registrar in Public Health Medicine / Honorary Clinical Lecturer

Dr Anita Houghton
Consultant in Public Health, London

Professor Walter W Holland, CBE
LSE Health and Social Care, London School of Economics

Dr Peter Horby
Senior Clinical Research Fellow, University of Oxford

Julie Hotchkiss
NHS Consultant in Public Health, Wigan

Dr Rob Howard
NHS Public Health Specialty Registrar

Dr Jonathan Howell
Consultant in Public Health, West Midlands Specialised Commissioning Team

Clare Humphreys
Specialty Registrar in Public Health, NHS Yorkshire and the Humber

Professor David Hunter
Professor of Health Policy and Management, Durham University

Louise Hurst
Public Health Specialty Registrar, University College London

Dr Sandra Husbands
NHS Consultant Public Health Medicine

Dr Sabina Fatima Hussain
Specialist Registrar in Public Health

Jan Hutchinson
Director of Public Health

Paul Iggulden
Independent Public Health Specialist

Dr Chikwe Ihekweazu
Consultant Epidemiologist, Health Protection Agency

Kathryn Ingold
Public Health Speciality Registrar, Leeds

Dr Maggie Ireland
North East Public Health Doctor

Dr Helene Irvine
Consultant in Public Health Medicine, NHS Greater Glasgow and Clyde

Dr Richard Jarvis
Consultant in communicable disease control and public health medicine, NHS Merseyside

Charlotte Jeavons
Programme Leader, Public Health, University of Greenwich

Dr Anna Jones
Teaching fellow at Brighton and Sussex Medical School

Margaret Jones
Consultant in Public Health, NHS Sefton

Lesley Jones
Deputy Director Public Health, NHS Bolton

Professor Frank Kee
UKCRC Centre of Excellence, Queens University Belfast

Dr Gifford Kerr
Consultant in Public Health, NHS Blackburn with Darwen

Dr Anuj Kapilashrami
Lecturer Global Public, University of Edinburgh

Dr S Vittal Katikireddi
Clinical Research Fellow, MRC/CSO Social and Public Health Sciences Unit & Specialty Registrar in Public Health Medicine, NHS Lothian

Dr Marko Kerac
Specialty Registrar & Academic Clinical Fellow, Public Health

Dr Mark Lambert
NHS Consultant in Public Health Medicine

Professor Tim Lang
School of Health Sciences, City University London

Dr Rajalakshmi Lakshman
Clinical Scientist and Honorary Consultant in Public Health, Addenbrooke's Hospital, Cambridge

Dr Bruce Laurence
Acting Director of Public Health for Derbyshire

David Lawrence
Consultant in Public Health, NHS SE London

Mike Leaf
Acting Director of Public Health, NHS North Lancashire

Ben Leaman
Specialist Public Health Registrar, Yorks & Humber

Dr Conan Leavey
Senior Lecturer Public Health, Liverpool John Moores University

Dr Joyce Leeson
Retired Senior Lecturer in Public Health, Manchester University

Dr Nicholas Leigh-Hunt
Public Health Registrar, NHS Leeds

Professor David Leon
Professor of Epidemiology, London School of Hygiene & Tropical Medicine

Valerie A Little
Director of Public Health, Dudley

Mary Lyons
Public Health Specialist, NHS Central Lancashire

John Lucy
Associate Director of Public Health, Liverpool Primary Care Trust

Dr Helen Maguire
Health Protection Agency, London

Dr GJ MacArthur
Academic Public Health Training Fellow, University of Bristol

Professor Alison Macfarlane
Professor of Perinatal Health, City University London

Dr Frances MacGuire
Specialist Registrar, Public Health

Dr Paul Madill
Specialty Registrar in Public Health, NHS South of Tyne and Wear

Dr Alexis Macherianakis
Consultant in Public Health Medicine, Sandwell PCT

Shepherd Masara
Associate member of the Faculty of Public Health

Dr Mashbileg Maidrag
Consultant in Public Health, NHS Suffolk/Suffolk County Council

Alan Maryon-Davis
Hon Professor of Public Health, Kings College London and Immediate Past President of the UK Faculty of Public Health

Dr Christina Maslen
Clinical Effectiveness Lead, Public Health Directorate, NHS Bristol

Dr Rebecca Mason
Specialty Registrar (Public Health), Mersey Deanery

Sue Matthews
Public Health Specialty Registrar, Hertfordshire PCT

Dr Eleni Maunder
Retired Senior Lecturer in Nutrition, Bournemouth University

Janet Maxwell
Director of Public Health, NHS Berkshire West

Dr Melanie Maxwell
Associate Medical Director and Public Health Specialist, Wirral University Teaching Hospital

Dr Gerry McCartney
Public Health Consultant, NHS Health Scotland

David McConalogue
Speciality Registrar in Public Health

Dr David McCoy
Associate Director of Public Health and Consultant Public Health Medicine, Inner North West London PCT, NHS

Amy McCullough
Public Health Specialty Registrar

Professor James McEwen
Emeritus Professor in Public Health, University of Glasgow

Lynne McNiven
Public Health Consultant, Assistant Director of Public Health, NHS Lincolnshire

Dr Sarah McNulty
Assistant Director of Public Health, Quality and Health Protection, NHS Knowsley

Professor Klim McPherson
Visiting Professor of Public Health Epidemiology, University of Oxford

Dr Jeff Mecaskey
Fellow of the Faculty of Public Health

Elaine Michel
Interim Director of Public Health, NHS Tameside & Glossop

Professor Susan Michie
Professor of Health Psychology, University College London

Dr John Middleton
Senior NHS Director of Public Health

Dr May Moonan
Clinical Lecturer in Public Health Medicine and NICE Scholar/Specialty Registrar in Public Health, University of Liverpool

Professor Robert Moore
School of Sociology, Social Policy and Criminology, University of Liverpool

Dr Gemma Morgan
Academic Public Health Training Fellow, University of Bristol

Maria Morgan
Lecturer in Dental Public Health, Cardiff University School of Dentistry

Dr Andrew Mortimore
Director of Public Health, Southampton

Dr Anna Morris
Specialty Registrar in Public Health, NHS Hampshire

Maggi Morris
Director of Public Health, Central Lancashire

Aldo Mussi
Senior Lecturer in Public Health, Birmingham City University

Dr Bernadette Nazareth
Consultant in Communicable Disease Control, HPA Norfolk Suffolk and Cambridgeshire

Professor Angus Nicoll, CBE
Former Director, Communicable Disease Surveillance Centre, Health Protection Agency

Dr Rory O’Conor
Consultant in Public Health, Wakefield PCT & YHPHO

Claire O'Donnell
Clinical Effectiveness Specialist in Public Health, North West Specialised Commissioning Team

John O'Dowd
Consultant Public Health Physician (Child Health), NHS Scotland

Professor Eileen O’Keefe
Professor of Public Health, London Metropolitan University

Dr Donal O'Sullivan
Consultant in Public Health Medicine, NHS South East London

Dr Ifeoma Onyia
Public Health Physician

James Lindley Owen
NHS Consultant in Public Health

Dr Kishor Padki
Consultant in Public Health Medicine, NHS South West Essex

Dr Arun Patel
Associate Director of Public Health, South West Essex PCT

Dr Matthieu Pegorie
Specialty Registrar in Public Health, NHS Trafford

Dr David Pencheon
Director, NHS Sustainable Development Unit (England

Sarah Phillips
Public Health Intelligence Analyst, NHS South Gloucestershire

Professor Kate Pickett
Professor of Epidemiology, University of York

Dr Mary Pierce
Clinical Epidemiologist, MRC Unit for Lifelong Health and Ageing

Dr David Pitches
Locum Consultant in Public Health, NHS Walsall

Professor Tanja Pless-Mulloli
Institute of Health and Society, Newcastle University

Dr George Pollock
Honorary Senior Research Fellow, University of Birmingham

Professor Jennie Popay
Professor of Sociology and Public Health, Lancaster University

Dr Debora Price
Senior Lecturer, Gerontology, King's College London

Alison Pritchard
Consultant in Public Health, Derbyshire County PCT

Dr Angela E Raffle
Consultant in Public Health, Bristol

Professor Rosalind Raine
Professor of Health Care Evaluation, University College London

Thara Raj
NHS Public Health Manager

Dr Giri Rajaratnam
Deputy RDPH, East Midlands NHS

Professor Salman Rawaf
Director of the WHO Collaborating Centre for Public Health Education, Imperial College London

Mr Abdul Razzaq
Joint Director of Public Health and Senior NHS Public Health Consultant

Dr Arif Rajpura
Director of Public Health, NHS Blackpool

Dr Boika Rechel
Clinical Lecturer in Public Health and Honorary Consultant in Public Health Medicine, University of East Anglia

Dr Paul Redgrave
Consultant Public Health

Professor Margaret Reid
Professor Emeritus, Public Health, University of Glasgow

Dr Mark Reilly
Assistant Director Public Health Intelligence, NHS Tees

Becky Reynolds
Speciality Registrar in Public Health, Yorkshire and Humber Deanery

Professor Jammi Rao
Visiting Professor in Public Health, Staffordshire University

Prof Jennifer Roberts
Prof Emeritus in Economics of Public Health, LSHTM

Dr Heather Roberts
Director of Postgraduate Education, School of Community Health Sciences, City Hospital, Nottingham

Professor Paul Roderick
Professor of Public Health, University of Southampton

Helen Ross
Hon Member of the Faculty of Public Health

David Ross
Consultant Public Health Medicine

Dr Eleanor Rutter
Public Health Specialist Registrar, NHS Sheffield

Prof Harry Rutter
Director, National Obesity Observatory

Dr Alison Rylands
Director of Public Health, North West Specialised Commissioning Team

Dr Vanessa Saliba
Public Health Specialty Registrar, Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine

Martin Schweiger
Consultant in Communicable Disease Control, West Yorkshire Health Protection Unit

Dr Sonya Scott
Specialty Registrar in Public Health Medicine

Dr Alex Scott-Samuel
Senior Clinical Lecturer in Public Health, University of Liverpool

Dr Anjila Shah
Consultant in Public Health, NHS Sefton

Professor Prakash Shetty
Professor of Public Health Nutrition, Southampton University

Dr Mohit Sharma
Specialty Registrar in Public Health, Oxford Deanery and University of Oxford

Dr Sally Sheard
Senior Lecturer in History of Medicine, University of Liverpool

Jessica Sheringham~
Specialty Registrar in Public Health, North London

Dr Khesh Sidhu
NHS Consultant in Public Health Medicine

Professor Peter Sims
Honorary Teaching Fellow, Peninsula Medical School

Dr Katherine Smith
Lecturer in Global Public Health, University of Edinburgh

Professor Alwyn Smith CBE
Past President, Faculty of Public Health

Dr Jenifer Smith
Director of Public Health and Chief Medical Advisor, Isle of Wight NHS PCT

Victoria Smith
Health Improvement Officer, Blaby District Council

Dr Tasmin Sommerfield
Consultant in Public Health, NHS Lanarkshire

Dr Rosamund Southgate
Public Health Specialty Registrar, Oxford Deanery

Dr Dan Seddon
NHS Public Health Consultant and Public Health Educator

Dr Ruth Stern
Honorary Visiting Fellow, London Metropolitan University

Dr Alex G Stewart
Consultant in Communicable Disease Control, Cheshire & Merseyside HealthProtection Unit

Professor Tony Stewart
Professor in Public Health / NHS Consultant in Public Health, Staffordshire University

Dr Alex Stirling
Specialty Registrar in Public Health, NHS Greater Glasgow and Clyde

Dr Ljuba Stirzaker
Consultant in Public Health Medicine, NHS Buckinghamshire and Oxfordshire Cluster

Laura Stroud
Lecturer in Public Health, University of Leeds

Dr Graham Sutton
Consultant in Communicable Disease Control, Leeds

Professor Stephanie Taylor
Professor in Public Health and Primary Care, Queen Mary University of London

Dr David Taylor-Robinson
Clinical Lecturer in Public Health, University of Liverpool

Alison Tennant
Specialist in Pharmaceutical Public Health, NHS Dudley

Sarah Theaker
Specialty Registrar in Public Health, NHS Nottinghamshire County

Richard Thomson
Professor of Epidemiology and Public Health, Newcastle University

Martin Tobin
Professor of Genetic Epidemiology and Public Health, University of Leicester

Dr Daniel Todkill
SpR in Public Health Medicine

Julie Tolhurst
Health Improvement Practitioner, Public Health Directorate, NHS Kirklees

Dr Caroline Tomes
Public Health Specialty Registrar, NHS Cambridgeshire

Dr John Tomlinson
Deputy DPH, NHS Nottinghamshire and FPH East Midlands Local Board Representative

Dr Paul S Turner
NHS Consultant in Public Health

Pat Turton
Senior Lecturer, University of the West of England

Linda Turner
Consultant in Public Health, NHS Sefton

Paul Turner
Consultant in Public Health, NHS Ashton, Leigh and Wigan

Ruth Twiggins
Head of Public Health: Health Inclusion Team, NHS Wakefield District

Louise Unsworth,
NHS Public Health Consultant, North East Public Health Observatory

Emily van de Venter
Public Health Speciality Registrar

Professor Edwin van Teijlingen
Centre for Midwifery, Maternal & Perinatal Health School of Health & Social Care, Bournemouth University

Dr Marie-Noelle Vieu
Fellow of the Faculty of Public Health

Dr Rebecca Wagstaff
Deputy Director of Public Health, NHS Cumbria

Dr Andy Wakeman
Senior NHS Public Health Consultant

Alice Walsh
Deputy Director of Public Health, NHS Gloucestershire

Sue Wardle
Public Health Specialist, South Staffordshire Primary Care Trust

Professor Richard G Watt
Department of Epidemiology and Public Health, UCL

Dr Joanna Watson
Unemployed Public Health doctor, Leicester

Dr Helen Webster
Speciality Registrar in Public Health, West Midlands

Sarah Weld
Public Health Specialty Registrar, NHS Wiltshire

Dr Jane Wells
NHS Public Health Physician, Oxford

Professor Robert West
Director of Tobacco Research, Department of Epidemiology and Public Health, University College London

Dr Ben Wheeler
Research Fellow, European Centre for Environment & Human Health

Professor Peter Whincup
Professor of Epidemiology, University of London

Professor Martin White
Professor of Public Health, Institute of Health & Society, Newcastle University

Professor Margaret Whitehead
Professor of Public Health, University of Liverpool

Dr Lisa Wilkins
Consultant in Public Health Medicine, NHS Oldham

Dr Ewan Wilkinson
NHS Public Health physician, Liverpool

Professor John Wilkinson
Professor of Public Health, Durham University

Professor Charles Wolfe
Professor of Public Health, King's College London

Dr Ingrid Wolfe
Child Public Health Research Fellow and Paediatrician

Dr Fiona Wright
Assistant Director of Public Health, Haringey

Huda Yusuf
Specialist Registrar Dental Public Health, North West & North Central London Primary Care Trusts

Dr Helen Zealley, OBE
Former Director of Public Health, NHS Lothian

Dr Rosemary Millar
Specialty Trainee in Public Health, NHS Tayside

Jay Succaram
Senior Lecturer, College of Nursing, Midwifery and Healthcare, University of West London

Dr Rachel C Thorpe
Specialty Registrar in Public Health, NHS Lanarkshire

Dr Celia Duff
Specialty Training Programme Director, East of England

Dominic Mellon
Specialty Registrar - Public Health, South West Public Health Training Programme

Helene Denness
Specialty Registrar in Public Health, Babington Hospital

Dr Ayoola Oyinloye
Consultant in Public Health Medicine, NHS Swindon

Dr Ardiana Gjini
Consultant in Public Health Medicine, NHS Bristol and NHS North Somerset

Dr Hynek Pikhart
Senior Lecturer in Epidemiology, University College London

Dr Joshna Ahir
Specialty Registrar in Public Health, Yorkshire and The Humber

Dr Nora Pashayan
Senior Clinical Lecturer in Applied Health Research, University College London

Shaukat Ali
Public Health Specialist, Sandwell Primary Care Trust

Julie George
NIHR Doctoral Fellow, University College London

Dr Andy Liggins
Director of Public Health, Peterborough

Dr Tasmin Sommerfield
Consultant in Public Health, NHS Lanarkshire

Dr Rosemary Millar
Specialty Trainee in Public Health, NHS Tayside

Professor Eileen Kaner
Director of the Institute of Health and Society and Professor of Public Health Research, Newcastle University

Dr Alison McCallum
Director of Public Health and Health Policy, NHS Lothian

Dr Eleanor Hill
Public Health Specialist, Stockport PCT

Kevin Elliston
Interim Associate Director of Public Health and Visiting Professor in Public Health, NHS Plymouth

Dr Jo Williams
Specialty Registrar in Public Health, NHS Bristol

Dr Merav Kliner
SpR Public Health, Yorkshire and Humber

Jan van der Meulen
Professor of Clinical Epidemiology, London School of Hygiene and Tropical Medicine

Dr Lynne Hamilton
SpR in Public Health Medicine, Tayside NHS Board Public Health

Carl Mackie
Advanced Health Improvement Practitioner, Huddersfield

Veronica Killen
Senior Lecturer in Public Health, Northumbria University

Helen McAuslane
Public Health Specialty Registrar, Leeds

Anna Middlemiss
Specialty Registrar in Public Health

Elisabeth Smart
Consultant in Public Health, Dumfries

Dr Jane Bethea
Specialty Registrar in Public Health

Rachel Sokal
Public Health Specialty Registrar, NHS Derbyshire County

Lucy Douglas-Pannett
Public Health Specialty Registrar, NHS Leicester City

Dr Sakthi Karunanithi
Specialist Registrar in Public Health, NHS North Lancashire/NHS North West

Dr Brijender Rana
Consultant Public Health, SEC Specialised Commissioning Group

Dr Pratibha Datta
Consultant in Public Health, Outer North East London (ONEL)

Dr Jennifer Mindell
Clinical Senior Lecturer, University College London

Dr Amina Aitsi-Selmi
Specialist Registrar in Public Health, London

Jo Peden
Public Health Specialty Registrar, South West (North) Health Protection Unit

Dr Imogen Stephens
Consultant in Public Health Medicine, Solutions for Public Health, Oxford

Stephen Turnbull
Assistant Director of Public Health, NHS Barnsley / Barnsley MBC

Jonathan Gribbin
NHS Consultant in Public Health

Dr Kate Ardern
NHS Senior Public Health Consultant

Catherine Chiang
Consultant in Public Health Medicine, NHS Greater Glasgow and Clyde

Dr Olusola Aruna
Consultant in Public Health Medicine, NHS Gloucestershire

Professor Ian Watt
Professor of Primary and Community Care/Hull York Medical School

Dr Nigel Field
Academic Clinical Lecturer, University College London

Dan Seddon
NHS Halton and St Helens / Merseyside and Cheshire Cancer Network

Gaynor Scholefield
Public Health Manager, NHS Calderdale

Prof. Rod Thomson
Director of Public Health, Shropshire County PCT

Dr Katherine Russell
Specialty Registrar in Public Health, NHS North Central London

Dr Angela Bhan
Director of Public Health, Managing Director - Bromley BSU

Abigail Knight
Specialty Registrar in Public Health, NHS Camden

Dr Lucy Reynolds
Consultant Paediatrician, Maternal and Child Public Health Team, NHS Greater Glasgow and Clyde

Dr Tim Daniel
Consultant in Public Health

Dr Julian Mallinson
Consultant

Dr Mike McHugh
Consultant in Public Health

Glenda Augustine
Specialist Trainee in Public Health

Sue Weaver
Public Health Manager, NHS Gloucestershire

Dr Stephen Watkins
Director of Public Health, NHS Stockport

Dr Sian Williams
Consultant in Occupational Medicine, London

Crossbench peers invited to Downing Street?

Dr Grumble is beginning to move in high circles. Yesterday he learned from two independent sources that the crossbench peers are being invited to Downing Street to discuss Lansley's Health and Social Care Bill.

The problem with parliament, the Commons particularly, is that most MPs just do what they are told. To be fair, MPs are busy. The NHS Bill is just one of very many things they have to do. Reading it, for most, is not an option and failing to follow party orders has dire consequences for an MP's career progression. Doctors in the new NHS know what this is like. Dr Grumble is anonymous because he wants to say what he believes and not what his NHS masters want him to believe.

The Lords is very different from the Commons. While some of the people there are career politicians who have been pensioned off and given a seat in the best day centre in the land, many others have found another route there. Quite often these will have special expertise in one area or another. This, of course, is vital. Dr Grumble is actually a supporter of the House of Lords. He is even a supporter of the only elected members of the Lords, the hereditary peers. It can't be justified. All Grumble can say is that over the years he has met a few MPs and a few lords. Most of the lords he has met have been patients - all NHS patients (including one hereditary peer). He has been impressed by every single one.

Grumble met another peer when he was a civil servant nearly two decades ago. Grumble had to go to a deprived part of the country to open a new facility. It doesn't matter what it was. To say exactly would identify Grumble. Few if any of Grumble's readers would ever have visited one of these places. Grumble, because of his own special expertise, has lost count of the number he has visited including some abroad. Suffice it to say that a private company had been given sweeteners to set up one of these facilities in a deprived part of Teeside. The Minister was to open it but, as ministers do, he cancelled at the very last moment and a lord was sent up from London instead. The occasion was actually exceedingly boring and Grumble and the noble got chatting over the canapes. The lord had taken the train North and he told Grumble that at one stop a whole lot of mentally impaired people got on the train with their minders and sat next to him. At the next stop the minder called them all off leaving the noble alone in the carriage. Then the minder called to Grumble's noble friend and dragged him off too. "No, no, I'm from the House of Lords!" he said.

You can only tell that joke if you are from the House of Lords and it made Grumble chuckle. He has remembered it all those years. It's not really PC but Grumble liked it. He has liked all the lords he has met and he likes the House of Lords.

Now what is the point of all this sycophantic rambling? It is to explain that these people in the House of Lords are nice fair-minded types who have a sense of vocation and dedication. Some of them can be relied upon to look after the NHS, which they too use. Many members of the lords are spoken for. They wear a party badge just like most of those in the Commons. And, mostly, they will do what they are told. But, in the Lords, there is a big group of crossbenchers. These are people will no overt party affiliations who will do what is right according to the evidence. Already they are exerting their influence.

So, if it is true that the crossbench peers have been invited to Downing Street, you can be sure that there is a reason for this. And you can be sure that they will only hear the side of the story that Downing Street wants them to hear. So if you want them to hear what they should be hearing about the NHS Bill, you may need to get in touch will them. You can find out which lords are crossbenchers here along with their email addresses. Get writing now.

With thanks to Baroness Hussein-Ece (actually a Liberal Democrat), who has advised Grumble that brief emails with bullet points are appropriate, and to @UKHouseofLords with their helpful tweet. Yes, peers tweet!