- Conservative election poster 2010
A few recent news articles about the UK’s Conservative and Liberal-Democrat(Conservative) coalition government – the ConDem’s – brutal attack on the National Health Service.
The Health and Social Care Bill creates a legal basis for withholding or charging for health services, according to medico-legal experts.
In an article in the British Medical Journal, it is argued that the Bill will drive a transition to a US-style model where private health insurance is the norm for medical reimbursement.
The authors argue that by removing the legal obligation to provide free healthcare and creating a legal right to charge for it, the Bill amounts to “the legal destruction of the founding principles of the NHS”.
Allyson M. Pollock, David Price and Peter Roderick list the following legal consequences of the new legislation:
• The duty of the Health Secretary to secure free healthcare for the population of England and the duty of PCTs to secure health services for everyone living in a defined geographical area are both abolished.
• The new CCGs will determine the scope of services independently of the Health Secretary, and may delegate these decisions to commercial companies.
• Some health services will be arranged by local authorities, who will have new charging powers.
• The Health Secretary will have an extraordinary power to exclude people from the NHS.
Taken in combination, the authors argue, this is a sufficient legal framework for a transition from a free NHS to one that charges many people for many of the services they receive.
The recent amendment stating that the Health Secretary “retains ministerial responsibility to Parliament for the provision of the health service in England” does not restore any duty to ensure the provision of comprehensive services, the authors say.
They also note that unlike PCTs, CCGs will not have a duty to provide health services for everyone within a defined geographical area. They will also have fewer obligations in terms of what government-funded services they provide, being required only to provide ambulance services and ‘emergency care’.
CCGs will now have the power to determine whether provision of the following to individuals is “appropriate”: disease prevention, care of pregnant women and new mothers, care of young children, care of people who are ill, aftercare of those who have received treatment.
These decisions need not be made by NHS clinicians and can be delegated to the private sector. In addition, private providers of healthcare will draw up their own criteria for patient selection, and will not need to notify local authorities of any risk to patients through termination of a service.
An open-ended relationship is created between CCGs and local authorities, which can pass service responsibilities back and forth between them, thus deregulating the provision of integrated care. Charging powers are created for the protection and improvement of public health, including vaccination and screening services as well as preventative healthcare and health information.
Many areas of healthcare will cease to be mandated and therefore may no longer be provided free of charge.
The authors conclude: “Legal analysis shows that the Bill would allow reductions in government funded health services as a consequence of decisions made independently of the Secretary of State by a range of bodies.
“The Bill signals the basis for a shift from a mainly tax financed health service to one in which patients may have to pay for services currently free at point of delivery.”
In the week that David Cameron said he “does not care” how unpopular his NHS reforms have become, the Royal College of GPs has reiterated its staunch opposition to the Health and Social Care Bill.
Dr Clare Gerada, Chair of the RCGP, today clarified the view of the college after critics claimed she had “weakened” her position against the Health Bill. These accusations followed a letter to the prime minister from Dr Gerada, asking him to work with GPs to find “a stable way forward” in light of the NHS reforms.
You can read the letter to the PM here.
The 34,000 GPs currently working in the UK will face huge challenges if the proposed reforms become reality. It will be their responsibility to enact the changes mapped out in the Health Bill, which places £60 billion of public money in the hands of doctors with little experience of financial management. It also forces GPs to directly ration treatment, a move that undermines a key principle of healthcare: that doctors have their patients’ best interests at heart.
The RCGP remains opposed to the Health Bill, but recognises that the NHS must prepare for these changes to maintain the best possible care. Dr Gerada is calling for co-operation for the good of her patients, rather than for political point-scoring. This is in sharp contrast to the Prime Minister, who snubbed the RCGP and the British Medical Association during a recent Downing Street meeting on NHS reform.
Dr Gerada has issued a further statement, this time addressed to Nick Clegg, reaffirming the RCGP’s concerns. She asked the deputy prime minister to use his influence to withdraw the Health and Social Care Bill, and outlined her firm belief that “the reform the NHS needs could happen without this complex and confusing wholesale restructure.”
The PM should now respect the law, accept the court verdict and order the immediate release of the NHS transition risk register
[John Healey is former Shadow Health Secretary]
The government has dragged out its refusal to release this information for 15 months, while parliament has been legislating for the NHS changes and pressed ahead with implementation at the same time. It’s now near the end of the 11th hour for the NHS bill, with the legislation set to pass in the next fortnight. Next Tuesday is the final day for amending the health bill in the House of Lords. They are set to pass the bill on Monday 19 March, with the Commons expected to do the same the following day before the bill is sent to the Queen for royal assent.
This legal judgment must put an end to the government’s efforts to keep secret the risks to the NHS and the action it is taking to manage or minimise them. Parliament rightly expects this information before it takes the final irrevocable steps to pass the health bill. Ministers’ first reaction to the tribunal’s judgment is to stonewall, delaying any decision to accept or appeal against the verdict until after the end of the bill. This is wrong. The government has now lost twice in law. This is a legal and constitutional argument, not a political argument. It isn’t a matter of whether you are for or against the reforms. It’s about people’s right to know the government’s own assessment of the nature and scale of the risks it is running with the quality, safety and efficiency of our NHS.
David Cameron and Nick Clegg have both made a strong commitment to open government. They should now respect the law, accept this court verdict and order the immediate release of the NHS transition risk register.
What Britain now has is a blue-orange coalition, with the little-knownOrange Book forming the core of current Lib Dem political thinking. To understand how this disreputable arrangement has come about, we need to examine the philosophy laid out in The Orange Book: Reclaiming Liberalism, edited by David Laws (now the Chief Secretary to the Treasury) and Paul Marshall. Particularly interesting are the contributions of the Lib Dems’ present leadership.
Published in 2004, the Orange Book marked the start of the slow decline of progressive values in the Lib Dems and the gradual abandonment of social market values. It also provided the ideological standpoint around which the party’s right wing was able to coalesce and begin their march to power in the Lib Dems. What is remarkable is the failure of former SDP and Labour elements to sound warning bells about the direction the party was taking. Former Labour ministers such as Shirley Williams and Tom McNally should be ashamed of their inaction.
Clegg and his Lib Dem supporters have much in common with David Cameron and his allies in their philosophical approach and with their social liberal solutions to society’s perceived ills. The Orange Book is predicated on an abiding belief in the free market’s ability to address issues such as public healthcare, pensions, environment, globalisation, social and agricultural policy, local government and prisons.
The Lib Dem leadership seems to sit very easily in the Tory-led coalition. This is an arranged marriage between partners of a similar background and belief. Even the Tory-Whig coalition of early 1780s, although its members were from the same class, at least had fundamental political differences. Now we see a Government made up of a single elite that has previously manifested itself as two separate political parties and which is divided more by subtle shades of opinion than any profound ideological difference.