Lancet editor and doctors write: The fight for our NHS goes on

As the health bill becomes law, Richard Horton, editor of The Lancet, and doctors Jacky Davis and Jonathon Tomlinson issue a call to action
March 2012

Photo: DulcieLee/Flickr

Richard Horton: "With the government’s health and social care bill having passed through parliament, what now?

First, we must realise that although we may have lost the legislative battle, we have not lost the argument. When Labour’s Andy Burnham turned over the keys to the Department of Health before the 2010 election, the mandarins told him that if he came back there was only one issue to worry about – the money. What he could not do was devise another fantastically ambitious NHS reorganisation. The NHS had to be about quality and efficiency.

When Andrew Lansley’s bill was published, Burnham knew that proposals for the biggest upheaval in NHS structures since 1948 were not what the country could digest. The health select committee agreed. Running a £20 billion efficiency programme alongside a massive change in philosophy (a new era of private sector colonisation of health services) was simply reckless. Not one expert inside or outside government believes this is a sensible strategy.

We are about to see a phase of unprecedented chaos in our health services. Those of us who opposed the bill should not gloat as this confusion takes hold. People will die thanks to the government’s decision to focus on competition rather than quality in healthcare. The coming disaster puts even greater responsibility on us to overturn this destructive legislation and remove this undemocratic government.

Second, therefore, we must begin collecting rigorous and reliable information on what is happening to our health services. When the Conservatives introduced fundholding to the NHS in the 1990s, it took years before we learned that the promises ministers had made were false. There was no consistent improvement in services. There were no gains in efficiency. Patients did not benefit from giving greater autonomy to GPs over how they spent their budgets. But the news of this policy failure came too late to influence the political debate.

We can’t allow that delay to happen again. We need to ensure that health professionals who study the NHS – and there are many of them – turn their attention to the bill’s impact on the lives of those who will suffer the fragmentation and disintegration of services. We need to build the evidence base now to show how the government’s policy is hurting people.

Finally, we must convert our arguments and the evidence we accrue into effective opposition. Labour was slow to respond to the Cameron-Lansley assault on the NHS. Those of us outside politics need to work harder to provide the necessary tools to the only opposition we have left. That way I hope we can make the NHS the central issue in the next election. The health of this nation depends on it."

Richard Horton is editor of The Lancet.

Dr Jacky Davis: "It is inconceivable that we will all sit back and watch our NHS wantonly destroyed.  We must make it clear to coalition politicians that we will not forgive their anti-democratic behaviour. There are more than a million people working in the NHS; our votes and those of our friends and families will be used to punish the politicians responsible for this, both locally and nationally. We must also hold Labour to its promise to reverse the legislation when it is back in power.

The fight must go on in other ways too. Many groups have woken up to the dangers of the health bill and joined with campaigning organisations against it. Public health doctors, medical students and patients have all organised to protest and these groups can work together in future. There must be some sort of public statement, possibly a high-profile conference, to decide the way ahead and it must be made clear to politicians that the fight is not over.

We must monitor the changes to the NHS once the legislation comes into effect. By its very nature it will be increasingly difficult to know what is going on, as the service fragments and financial dealings and patient outcomes are lost behind a convenient curtain of ‘commercial confidentiality’. It is essential that we keep track of the bill’s effects if we are to show we were correct in our predictions of its dangers. The coalition will certainly not be telling us about the problems that arise, their predilection to massage the truth being only too apparent in their introduction of the bill in the first place.

Finally, we need an urgent inquest into the abysmal failure of medical ‘leadership’. Early and united opposition would have seen off the bill long ago. Instead our leaders, in trade unions and professional bodies, saw ‘opportunities’ and decided they could work with it on our behalf. When they were finally persuaded to see the dangers, their policy changed to seeking ‘significant amendments’, despite the fact that the government showed no sign of conceding any.

Few organisations conducted a proper campaign, even after being mandated to do so. The leaders of the professions were only moved to opposition after internal struggles and grass-roots organisation. They have not represented their members. They must be held to account for their failure and the whole structure of representation needs critical examination.

In sum, we will need a combination of actions such as continuing media coverage, evidence about the detrimental effects of the bill, protests, occupations and perhaps a refusal to co-operate with the legislation – for example, a boycott of the private sector. This battle may be over but the war is just beginning."

Jacky Davis is a consultant radiologist and British Medical Association council member. She is writing in a personal capacity

Jonathon Tomlinson: "The first priority must be to protect patients, in particular those who are least able to articulate their needs or access care. The health bill is intended to convert healthcare and patients into commodities. GP will be pitted against GP and hospital against hospital, vying for patients. Patients will be expected to compare GPs and hospitals in league tables and shop around, competing with each other for increasingly limited resources. Hospitals will be allowed to succeed or fail according to the values of the market, irrespective of patient need.

Since it is far more efficient and profitable to care for people who are motivated and able to care for themselves, it is those patients who are lacking motivation and ability who will be the first to suffer. Services for people with mental illnesses, dementia, drug addiction and language barriers are being cut first because those who depend on them are least able to complain. We will need to take urgent action to protect them. ‘Occupy Healthcare’ as a movement will exist to show that healthcare for vulnerable people cannot be run according to the same business ethics as industrial healthcare. Day hospitals will need to be occupied. There is now a daily picket at the gates of Chase Farm Hospital to keep it open, with a view to occupation to prevent the closure of A&E and maternity.

The NHS has entered the political consciousness of the public more than at any time since it began. One urgent need is for all of us to get involved with the new democratic structures, however toothless they may seem. These range from patient participation in GP surgeries and GP commissioning groups, and membership of Health Watch and health and wellbeing boards to standing as non-executive directors at foundation trust hospitals and so on.

Finally, we have to reject industrial healthcare. It is unsustainable, unhealthy and immoral. It’s time to bring humanity and sustainability back to the NHS."

Jonathon Tomlinson is a GP in Hackney.


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mark aitken 23 March 2012, 07.31

Jacky and Jonathan are absolutely right. We must endeavour to implement changes which are focussed on patients and not a bag containing an arbitrary number of beans.
Last night I was removed “sacked” from our local Foundation Hospital Trust (FHT) “board” of governors, essentially because I had the temerity to ask probing questions which the Board of Directors did not wish to answer and then had the audacity to raise the issue (and a number of other issues) with Monitor.
FHT governors, who should be champions of the catchment population (patients), are merely vassals handcuffed to the apron strings of the Board of Directors.
This highlights another aspect of “patient choice” which is as meaningless as the smiles on the faces of the Cabinet Ministers who engineered the Bill.

Salisbury 23 March 2012, 07.31

You would have thought that the editor of a peer-reviewed medical journal would wish to preserve some sort of reputation for objectivity and eschew the applause-seeking rhetoric of the bar-room politician. The veracity of phrases like “a new era of private sector colonisation of health services” and “a phase of unprecedented chaos in our health services” is dubious at best, but Richard Horton excels himself when he states that “people will die thanks to the government’s decision to focus on competition rather than quality in healthcare”. Not might die, or could die, but will die – said with a certainty that would be instantly disallowed if a drug company, for example, made such claims about the effects of one of its products, even with a bank of randomised control trial data behind it.

Where is Mr Horton’s evidence that the Government’s health reforms will kill patients – isolated that is from all the other factors, avoidable and unavoidable, that lead to people dying all the time while they are in the hands of the NHS? What studies can he cite, either from this country or from abroad, that might support this wild assertion? What credibility does he have calling for evidence about the impact of the reforms, when he is clearly someone who has already made up his mind?

It is also a little hilarious that somebody who states as his objective not just to oppose the reforms but to “remove” the Government, can claim to be working “outside politics”. Mr Horton is entitled to advance reasoned opposition to the Government’s policies, but this sort of gross and unsubstantiated language demeans both him and the office he holds.

Jonathon Tomlinson 23 March 2012, 10.47

Here are 2 papers about health literacy to back up my article above. In the first, adults over 65 years old were given 4 simple questions about a prescribed medication to answer. They could refer to an A4 leaflet explaining about the medication. Over 30% scored 0 or 1 out of 4. Questions included, how many days should you take this medication for?
The consequence of a consumer-driven NHS will be widening health inequalities, as those with lower health literacy are left with the worst services. This is explained by the Inverse Care Law which states, “The availability of good medical care tends to vary inversely with the need for it in the population served. This … operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced.” (Hart, 1971)

Robert Carter 23 March 2012, 11.17

As someone who has the NHS to thank, for saving not only my life, when I was left comatose after a car accident, saved my wife’s with ground breaking stem cell treatment, and my eldest sons.

I will dedicate every available hour I can to help anyone to get our NHS back, and to preserve it.

“the misery being heaped upon us, is but the passing of greed” C. Chaplin.

My best wishes go out to all those in the NHS who are standing up, for all of us.

Caroline Milford 24 March 2012, 12.34

One of the most appalling aspects of the coalition’s mendacity over this issue has been the dismissal of expert medical opinion as ‘vested interests’ and ‘self interest’, elements of the right wing electorate’s willingness to accept this lie and the population’s gullibility in believing that carpetbaggers like McKinsey are going to put patient care before profit. It is a national disgrace. Inasmuch as I had ever considered the integrity of the medical profession as a whole, I now rate it more highly than ever.

I just hope and pray that those GPS who have pledged to stand against coalition MPs are true to their word because I stand ready to assist in any way I can, as do many of my acquaintance.

I will bang the table when these vested interests are unseated from Parliament.

Dr chris burns-cox 24 March 2012, 18.53

We need a central place to collect details from the public and professionals of any change in the way the NHS is working which is to the detriment of patients or the organisation.
Perhaps 38 degrees would be the right place but this needs to be discussed and publicised NOW.
Certainly this needs to be from the date of the passage of the bill but it could be debated that we should analyse deterioration in the service from the start of the Enthoven-Thatcher-Clarke erosions or perhaps merely from the date of the last general election.

Time for civil disobedience 25 March 2012, 01.14

We have been down the Parliamentary road, and – as when 1 million-plus protested against the Iraq War – we were ignored. The best path open to us now is obstructing any changes and civil disobedience… Blockade Virgin Healthcare and all the other private companies jostling for a way in, for starters… A list needs to be compiled of targets and spread widely. History shows this is really the only way to achieve your aims. Oh, and, aside from the GPs stating their intention to stand on Save Our NHS tickets in a selection of places, what do Red Pepper readers think about the idea of fielding candidates in EVERY constituency as a broad-left replacement for Labour, who are selling us out all the way?

Giselle Williams 27 March 2012, 10.09

Salisbury – I’ll speak for any person you’ve come on here to malign and misinform with your rubbish Tory/DrumLib propaganda.

1. How much are your earning out of the privatisation/dismantlement for profit of the ENGLISH NATIONAL Health Service?

2. What is the name of your Private Health Provider?

3. How much do you have to pay for this Private Health provision or, if it is at no “cost” because you are a connected or interested employee or investor, what is the amount of the Benefit in Kind of your provision?

4. If there is no Benefit in Kind of your Private Health provision here, because you are located for tax overseas, why are you here b*ggaring up the ENGLISH NATIONAL Health Service?

5. How old are you and how likely are you to require the facilities of the ENGLISH NATIONAL Health Service in the next 10 years? (Don’t bother to answer that question if you’re under 21 and immature so far).

6. Have you noticed lately that even the right wing press (apart of course from the unfortunately bowed and censored BBC with A Tory at it’s helm) is beginning to see through YOUR TORY/DRUMLIB PROPAGANDA?

Please forgive me for having a rant but the wonderful NHS where I live saved my life in A&E two weeks’ ago and I object strongly to the ENGLISH NATIONAL Health Service being laid wide open (after substantial improvements) to foreign and UK healthcare vultures such as (she spits!) KPMG’s Mark Britnell – the NHS will be shown no mercy and will become an insurance service, and McKinsey whose only purpose for existing is profit rather than people’s lives and welfare.

Giselle Williams 27 March 2012, 10.17

Oh, and by the way, Salisbury – how you getting on with that Risk Register?

I’ve figured out now who you are! You’re either a paid-for external at the DoH or you’re actually Lansley. Know how I got that? Because both of those almost unmentionably disreputable parties are always asking others to come up with the data, the qualifications, the research but your lot never do, do they?

My qualifications for spouting out against your comments are that you have been more rude than I could be about someone without knowing them, as you obviously didn’t when sending your nasty comments. Two can play at your little game!

My further qualifications for rubbishing your comments are that I am a citizen of England (although born in Scotland), I am nearly 65, I have paid my taxes all through my life and I am utterly disgusted at the way my rights as a citizen and voter have been shabbily stamped on by this disgusting and abject betrayal of democracy – exhibited by a bunch of LIARS.

Susanna Rees 28 March 2012, 20.20

You could collect local data on waiting times in your town or village.

Publicise it on a well-konwn community website and ask local people (or younger members of their family) to update if they are experiencing a long wait.

Let local councillors / MPs / GPs know you are doing this. Write to the papers saying you are doing this. Put notices up near your local GP surgeries? In shop windows, on notice-boards, in local churches, let the public know that if they are experiencing long waiting times, there is a place, independent of DoH, that they can log this.

Mark Struthers 29 March 2012, 08.11

Farewell NHS: I’m very sorry you had to go. The NHS was a powerful symbol of national togetherness, of social cohesion, of solidarity, of cooperation, of people working together for the health of the individual and the common good. Goodbye: it was good to know you and I’m very sad to see you gone.

Mark Struthers 3 April 2012, 14.57

In a revealing BBC Radio 4 programme last year, listeners were told that the Lancet sits alongside the BMJ as one of the “twin pillars of the British Medical Establishment”.

The programme provided a unique insight into how the ‘twin pillars’ behave when government reputation and industrial interests are genuinely threatened. In my opinion, the view from the pillars was uniquely unpretty.

Mark Struthers 4 April 2012, 09.37

In writing ‘Intelligent Kindness: Reforming the Culture of Healthcare’, John Ballatt and Penelope Campling have written an excellent book on the only reform of the NHS that was really needed. I expect Jonathan Tomlinson and Jacky Davis have read it, and even the editor of the Lancet, a pillar of the Medical Establishment, has probably read it too. I commend it to a wider audience.

The following is the product description from Amazon,

“Intelligent Kindness is a powerful new approach to healthcare reform. Ballatt and Campling argue that the NHS is a system that invites society to value and attend to its deepest common interests; it is a vital expression of community and one that can improve if society, patients and staff can reconnect to these deeper values. To do so will improve quality and patient experience, as well as morale, effectiveness, efficiency and value for money. Relentless regulatory and structural NHS reforms have failed to avert scandals and left many health service staff feeling alienated. Industrial and market approaches to reform, whatever their merits, urgently need to be balanced by an applied understanding of what motivates and assures compassionate practice. The authors examine this topic from a wide variety of perspectives, including psychoanalytic thinking, group relations, neuropsychology, social psychology and ethology. This book calls on policymakers, managers, educators and clinical staff to apply and nurture intelligent kindness in the organisation and delivery of care, and offers advice as to what this approach means in practice.”

Mark Struthers 4 April 2012, 09.44

The passing of the NHS Bill, the Budget, and other recent governmental cock-ups, have proved that the current British government is corrupt, cynical … and crap. The election of George Galloway is also pudding proof that the electorate think that there is little difference in the usual political alternative. And the appalling behaviour demonstrated in Science Betrayed (see link above) would seem to have proved beyond any reasonable doubt that the ‘British Medical Establishment’ are just as crappy.

Comments are now closed on this article.

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