Dear Priti Patel, MP
I have been asked by one of my members to respond to a letter sent to her from your office on the issue of the governments Health and Social Care Bill. Your letter epitomises the problems that many health workers and others concerned about consequences of the Bill have had in getting a straight answer to central questions from government ministers and Tory MPs.
You insist that “much of the information being spread about the legislation by those who oppose it is inaccurate or misleading”: but to support this argument you tell us that “EU competition law already applies in the UK” – ignoring the specific concern raised by UNISON, other health unions and even many of your party’s coalition partners, the Liberal Democrats.
They all point to detailed legal opinion suggesting that the restructuring within the NHS Bill makes it far more likely that EU competition law will potentially begin for the first time to apply to Foundation Trusts and Clinical Commissioning Groups – and will also make the whole process of procurement and tendering far more complex and bureaucratic than it has been up to now (additionally wiping out many if not all of the savings which you claim might come from cutting “waste and bureaucracy”).
You dismiss the concerns of those who point out that the first clause of the Bill – even after substantial amendment – threatens to remove the duty of the Secretary of State to provide health services for the whole population. You answer by referring to a different clause, which addresses a different question. But you must be aware that the concerns among all parties over Clause 1, and the very question of the Secretary of State’s “duty to provide” have now brought the Bill to a grinding halt in the House of Lords, with the government facing potential defeat, and any vote on this contentious proposal postponed until the New Year.
You brush aside concerns that the Bill is “dismantling and privatising the NHS”: but the existing management structure is being visibly demolished before your eyes, with PCT and SHA staff being reduced at a frightening rate, leaving these bodies stripped of vital skills, while it is increasingly obvious to all – including the GPs themselves – that GPs do not have the skills, time or energy to run the complex “commissioning” process proposed in the Bill.
Many GPs realise that with budgets frozen or falling in real terms for the next three years, the role of commissioner means to act as a rationing board, deciding which services to scale back or close down: in Mid Essex alone GPs are being called upon to make “savings” equivalent to £33 per person on their list to tackle the “efficiency” target.
Privatisation is not just focused on the creation of a new competitive market in health care and the requirement to allow “any qualified provider” to compete for a steadily growing range of health services – allowing companies to pick which profitable services to bid for while potentially bankrupting fragile NHS hospitals and services. Privatisation will also penetrate deep into the “commissioning” bodies themselves: as the CCGs are launched (months before the new structure even gains parliamentary approval), private companies are already lining up to take over the actual day to day management roles that were once done by public employees. They will draw up plans, proposals, accounts – and handle contracts with other private companies, with CCG Boards as a rubber stamp. Private companies are even now operating “referral management centres” which routinely second guess the decisions of GPs and choices of patients.
Add to this Mr Lansley’s determination to remove the limits on the money that Foundation Trusts can make from private medicine (while the funding and tariff for NHS patients are frozen and falling in real terms) and the direction of change is clear. Dwindling resources, redundancies, frozen vacancies, cuts and closures for the NHS on the one hand, with incentives to switch NHS resources to wealthy fee-paying patients – and on the other hand a bonanza for private companies such as Ramsay, UnitedHealth, Assura Medical, PriceWaterhouseCoopers, McKinsey’s and others.
As you should know, GPs have shown their opposition to the Bill in every poll since the White Paper was published (most recently 78% against the Bill in an RCGP poll) while just one GP in every SIX wants anything to do with the commissioning role Mr Lansley is trying to foist upon them. The BMA has called for the Bill to be withdrawn. Every one of the Medical Royal Colleges is critical of the Bill. Every health union is opposed to it. So is almost every think tank that is not hooked up with the private sector. The Lib Dem conference was overwhelmingly critical and demanded major changes, few of which have been conceded.
The Bill is being pushed through in a context that former Conservative Health Secretary Stephen Dorrell has pointed out requires the NHS to make four successive years of cuts – with a target bigger than any health system anywhere in the world has managed to achieve.
Figures show growing waiting times and problems accessing hospital care: thousands are finding their operations are postponed to save money, tens of thousands more in Essex and elsewhere have discovered that a rising list of treatments once freely available can no longer be accessed on the NHS, giving them the “choice” of going without or going private.
So if you think you have had problems up to now with constituents not receiving the care they need, you should brace yourself for ever greater numbers of disgruntled constituents, painfully realising that Andrew Lansley’s Bill is designed to “liberate” and enrich the private sector – at the expense of our NHS.
Perhaps you would have been better informed on the problems raised by Mr Lansley’s hugely contentious reforms if he had not prevented you, and every other MP from reading the “risk register” identifying the issues of concern, which he has suppressed since February, and has now been instructed by the Information Commissioner to publish.
It is clear that the debate in the Commons was skewed by this deliberate withholding of information, which the Lords are now demanding be made available to inform their debates. Perhaps it is an indication that even Mr Lansley realises how fragile is the tissue of deceptions, falsified figures and assertions on which the credibility of his Bill rests. He is taking you and other loyal Conservative MPs for idiots, feeding you with partial and misleading answers, while his plans unravel and the NHS slides towards chaos.
I hope you will be among the MPs demanding immediate public access to the risk register, and studying this document yourself before offering more superficial answers and statements.
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