More Tory NHS myths

Thanks to John Lister for this.

Reproduced below is what looks very much like a form letter from Tory Central office in response to a journalist’s letter on the 38 Degrees campaign.
The letter obviously has a local element (the reference to Oxfordshire), but consists largely of national-level lies and evasions presented as a series of ‘myths’.

I thought it might be useful to circulate the letter in case campaigners receive similar replies from other Tory MPs, and the response which I have drafted.

The letter from the Tory MP

Thank you for contacting me about the NHS.

The changes we want to see are simple ones.

• first, where patients have greater choice and control over how and where to be treated;

• secondly, where the NHS is left free from political interference to focus on what really matters – i.e. that patients get the best possible care;

• thirdly, where doctors and nurses are driving improvements in patient care, and are supported by high-quality management.

The Health and Social Care Bill sets out how, in legislative terms, we will meet these aims.
We all recognise that there are concerns; change of any sort always brings concerns. But, many of these concerns are based on myth, which the 38 degrees campaign reiterates and promotes. I know it may be an inconvenient truth that the claims made about our reforms are myth; but myth they still are. This is not the first time that a 38 degrees campaign has been wrong. Its campaign on forests was also inaccurate and highly misleading and I am genuinely surprised that constituents continue to put their trust in them.
Let me set out what those myths are:

Myth 1: Our reforms amount to privatisation of the NHS

There is no privatisation of the NHS being proposed and it will not be proposed by this Government. Nothing in our plans undermines the fundamental principle of the NHS: that it delivers care free to all, funded from general taxation, and based on need and not ability to pay.
But that does not mean the NHS does not need to change. First, we want the NHS to be even better than it is, saving even more lives every day and giving more patients the best chance of living well with a long-term condition. Secondly, the pressures on our NHS – caused by an ageing population and more expensive treatments – are rising all the time.

Myth 2 The Government wants to break up the NHS
It does not.

Myth 3 Doctors and nurses are against our plans.

They are not. GPs in over 6,500 practices covering 45 million people have come forward to test the new arrangements. Doctors and nurses at the frontline are already making our proposals work for patients. Today, GPs are already taking responsibility for local NHS resources, free from interference from Whitehall.
Here in Oxfordshire you may have missed the comments from Dr Stephen Richards who will lead the county through these reforms and who has publicly discounted suggestions he would be overseeing the end of the NHS in Oxfordshire.
He had no doubts about the benefit of doctors being involved in key decision making: “There is general agreement that getting more clinical leadership in the health service is a good thing. But people should remember doctors will not be doing all this on their own. For two years we will have the benefit of working with PCT managers.”
Seventy-one of the county’s 83 practices voted in the election for Dr Richards.

Myth 4 The Government is not testing the changes

It is. Proposals to put GPs at the forefront of NHS decision-making have been tried and tested over two decades, including under the Labour Governments of Tony Blair and Gordon Brown. Secondly, plans to make every NHS Trust an NHS Foundation Trust were introduced by the previous Government in 2003. Thirdly proposals to allow patients to choose wherever they want to be treated have similarly been tried and tested over the last decade – and were supported by all three main parties at the last General Election.

Myth 5 Frontline care is not being protected: the Government

The Government is increasing the NHS budget by £11.5 billion. All the evidence shows that the NHS is delivering more for patients, with low waiting times. MRSA is at its lowest level since records began. More than 2,000 patients have access to new cancer drugs that would previously have been denied them. Those with symptoms of cancer now see a specialist more quickly than before. There is more transparency about hospital performance. .Since the General Election there are 3,000 fewer managers and 2,500 more doctors and 90% of the country will be covered by new Health and Well-being Boards.

Of course some concerns are genuine, and the Government hears those concerns. So, now that the Health and Social Care Bill has successfully completed its first stages in the Commons, the Government is going to take the opportunity of a natural break in the legislative process to reflect on how the plans might be improved. This is a genuine listening exercise. Where there are good suggestions to improve the legislation and the implementation of these plans, changes can be made.

However, whilst I do not believe playing the numbers game is at all relevant, the number of constituents who have contacted me about the NHS is only around 0.15% of the constituency population. The idea that there is a mass protest against these reforms is therefore also another myth.

If I am to write to Nick Clegg, David Cameron and Andrew Lansley as some have asked me to do I can see no reason why I would not want to urge them to stick to the principles of these reforms which are in the interests of the NHS, the patient and the taxpayer.

Regards
XXXX  MP
Member of Parliament
House of Commons
London, SW1A 0AA

The reply, courtesy of John Lister, London Health Emergency, Keep Our NHS Public

Dear Sir
Everything about your letter replying on the Health and Social Care Bill, the way it is constructed, and the issues it evades, demonstrate that you have not read the Bill and have no detailed awareness of its content.

It appears that you have just parroted briefings from your own party Central Office, and passed on a series of assertions that are not even shared by your coalition partners the Liberal Democrats.

You begin with three “principles”, none of which can seem to flow from the bill:

1.     Improved “patient choice”: yet we already know that one in eight referrals from GPs are currently being bounced back by “referral management’ bodies staffed by bureaucrats and accountants. Many patients will be denied their first choice of high quality, local services as NHS trusts are destabilised and services run down and closed as a result of the Bill and the accompanying so-called “efficiency savings”.
Nor will GPs be able to exercise any choice over which “willing providers” are included on the list which they’re compelled to offer as “choices” to their patients: the register of approved companies will be drawn up nationally by Monitor, with no mechanism for local input or scrutiny.

2.     You look to an NHS “free from political interference”: yet the Bill itself is massive political interference: the biggest ever top-down reform of the NHS, and imposed with no mandate by your party in government, with no public consultation on the merits of Mr Lansley’s  contentious proposals.
Worse, Clause 1 part one of the Bill deletes the existing duty of the Secretary of State to provide comprehensive and universal services free of charge. All duties are instead now devolved to the new NHS Commissioning Board – which the Bill makes clear will itself clearly be under the thumb of Mr Lansley and his successors, but in no way accountable to the wider or local public affected by its decisions.
So “freedom from political interference” actually means an end to political accountability in the House of Commons for the NHS, and opens the way for the NHS to be turned into a fund, purchasing from a competitive market in services, with much greater private sector involvement, presided over by the NHS Commissioning Board and Monitor.
One consequence is that local MPs like yourself will no longer be able to demand answers on NHS issues from ministers in Parliament. Do you regard this as a good thing?

3.     You say “doctors and nurses” would be given more freedom and control: but this too is a myth. Nurses are given no significant control at all by the Bill, and nor are hospital doctors: GPs are given the illusion of control, while in reality being constrained by a rigid cash limits on each consortium, and each consortium  will be policed from above by the NHS Commissioning Board. Under these conditions the consortia will be turned effectively into rationing boards deciding on local cuts, closures, and which services for their patients will no longer be available under the NHS.
While each of your principles turn out to be myths, each of the issues you brand as a “myth” turns out to be based on real sections and proposals in the Bill or flowing directly from the Bill and the drive for £20-£30 billion of so-called “efficiency savings” by 2014.

·     “Myth one”. On privatisation, you argue that this is a myth by narrowly defining privatisation as requiring patients to pay for treatment.

But you should be aware that the core of Lansley’s bill is the proposal to open all clinical services to competitive bids from  “any willing provider”, including for-profit private companies.

Monitor will have the primary role of enforcing competition, and is opening up space for new private sector providers, whether they be profit-seeking multinationals or non-profit social enterprises whose surpluses are not retained rather than given to shareholders.  Read the Bill:  this is what’s proposed.
So more private providers would be paid from taxpayer’s money, taking a growing slice of the NHS budget. That is privatisation.
To make matters worse, Monitor has already warned foundation trusts they should focus only on services that make a surplus – running like private businesses.  But if the Bill goes through, neither Monitor nor the Secretary of State would have any responsibility to prevent gaps opening up in the provision of services which neither the foundation trusts nor private sector providers would see as profitable.
So we will have a free market in health care provision, with no real safety net for services, and few if any public sector providers if Mr Lansley gets his way and Foundation Trusts are moved “off the NHS balance sheet” to become social enterprises.

You add in two irrelevant asides on improving the quality of NHS treatment and caring for the ageing population. Had you read the Bill you would know that it offers no significant proposals that would address either issue.
Instead it formalises the abolition of waiting time targets, and this measure has already begun to push waiting times sharply upwards and will clearly do so even more as the spending cuts take their toll each year to 2014.
Nobody regards longer waiting times as an improvement in the quality of care.

·     “Myth two”. You deny that the objective is to break up the NHS: yet this is precisely the effect of Lansley’s Bill, which by scrapping the existing wider management structures of the NHS – PCTs and SHAs – threatens to hand commissioning powers to a chaotic and random collection of GP consortia varying in size from 14,000 catchment population to 670,000.

GP consortia are not required by the Bill even to have a board structure, to meet in public, or to publish any board papers: nor are they even required to cooperate with their neighbouring consortia, or to consult on their plans.

If this is not fragmentation of the NHS, what is?

This loss of local strategic planning will inevitably worsen the tendency towards an unfair and arbitrary “postcode lottery” as various consortia take different decisions on the mix of services that should be offered to their patients.

With just one NHS Commissioning Board at national level overseeing the work of the consortia it seems impossible to ensure any equality in access to services from one part of the country to another.  In other words, as some professional bodies have pointed out, the Bill takes the ‘National’ out of the National Health Service.

Nor is this loss of coordination compensated by any genuine local accountability: not one of the Pathfinder consortia that have been set up so far was established through public consultation, and none of them are required by the bill to consult local people on any of their proposals and changed provision of services.

·     “Myth three”:  Laughably in the aftermath of the recent 99% vote of no confidence in Mr Lansley and his plans by the Royal College of Nursing, the mounting criticisms voiced by the BMA, the Royal College of General Practitioners and other professional bodies and the total opposition from all of the health unions, the letter clings to the illusion that Mr Lansley’s plans are not opposed by the majority of doctors and nurses.

At no point has more than one third of even the GPs who are supposed to benefit from his reforms shown support for Lansley’s plans in opinion polls.
Recent polls show that over 70% of GPs feel morale among GPs had been set back by the bill, and huge numbers of GPs planning to retire rather than implement Lansley’s plans.
It’s true that some GPs leading Pathfinder consortia argue that they will be given increased powers, and that they can use these powers to improve care for patients. But these GPs are either kidding themselves or wilfully deceiving local people: once the full impact of the growing spending restraints are felt by consortia, they will indeed be forced into cutting rather than expanding or improving local services.
Nor is there the slightest indication that the GPs who have led Pathfinder consortia enjoy any significant level of public support: local people were not asked, and those who are aware of these changes are in many cases extremely angry at what is being done to their National Health Service by unrepresentative GPs.

There is a further concern that in large consortia the needs of local groups of patients in more deprived areas are likely to be overlooked as the leading role is taken by GPs based in larger and better resourced practices in more wealthy areas. There is no mechanism to ensure that the Bill will not in this way widen rather than tackle inequalities. Instead we seem set for an escalating “postcode lottery” with the availability of services depending on where a patient lives.

·     “Myth four”:  the letter denies these policies are untested. But they are. It suggests you are unaware of the extent to which Lansley’s plan radically departs from this small scale and relatively marginal changes implemented – with no great success – under Labour since 2001.

The Bill is a huge, unprecedented experiment in marketisation of a system on a scale never attempted before anywhere in the world.
The King’s Fund, the  NHS Confederation and the Commons Public Accounts Committee have among many others warned of the potential hidden costs of the Bill and the dangers in terms of loss of control of health spending in a time of massive financial constraint.
You obviously know that the proposals in Lansley’s Bill were very deliberately NOT put to the test of the electorate in May 2010. They were in neither Tory nor Liberal Democrat manifestoes. Only now are they being forced through, with no mandate, by the coalition – despite the fact that one party in the coalition is now strongly arguing that key proposals are mistaken and must be dropped through amendments to the Bill.

·     “Myth five”: The letter denies that cuts are taking place in frontline care, despite the headlines in national and local newspapers almost every day itemising closures of beds, staff numbers being cut (many of them quite obviously “front line” rather than “back office” staff) and restrictions on local services available to patients.
George Osborne’s budget gave the NHS just 0.2% additional funding per year in theoretical terms after inflation: but with rising inflation this so-called increase amounts to a real terms cut every year until 2014.
In addition inflation is pushing up the cost of many PFI hospitals, bringing further real terms cuts  to many NHS trusts would have to foot the bill. On top of this the so-called “efficiency savings” are set to reduce the tariff of fees that hospitals are paid for delivering services to patients: this means that less and less money will be flowing in to trusts while levels of patient need are unlikely to be reduced by a similar amount.
The constraints on  NHS trust budgets is also important because Lansley’s Bill would remove the cap on the amount of money that foundation trusts are allowed to earn from treating private patients. So under the Bill while the amount of money available to treat NHS patients is squeezed and reduced, it becomes more and more attractive for foundation trusts to focus instead on bring in profitable paying customers from home and abroad, making NHS patients into second-class citizens in hospitals paid for through their own taxes.

It will be interesting to see your comments on this aspect of Mr Lansley’s Bill, which again it appears you have not read.

·     “Myth six”:  the letter raises what appears to be a sixth “myth”: that there is public anger at the Bill.
It’s true that many of the public know as little about the Bill as you and many other MPs.  It passed through two readings and the committee stage at the House of Commons without more than a handful of MPs noticing many of the issues which have now been raised by the Commons public accounts committee.
But you should not misread public ignorance and silence on the bill as support for the proposals. The public had been lied to and fed PR spin like your letter in order to mislead them on its content.
You should take note of the overwhelmingly critical points raised by a large majority of the Lib Dem conference, and the warnings raised by think tanks, the public accounts committee and others pointing to serious  and fundamental problems with the bill.

Even the man hand-picked by David Cameron to lead the so-called “listening exercise” on the bill, Prof Steve Field, has now come out and described it as unworkable, and potentially destabilising the NHS.
As the public wakes up to the threat that is posed  to their NHS, to their right to know about plans for the NHS, and to the  key principles of equity and access which were brought about by the NHS in 1948, you can expect more and more vocal protests at local and national level.

It would be helpful if you would look in detail at the Bill in the light of these points and maybe reconsider your uncritical support for plans which serve to discredit your own party and government, and which would undermine the foundations of our most popular and universal public service.
Perhaps you could also direct the authors of the PR material included in your letter towards the facts of the Bill which they find it necessary to avoid and misrepresent.

After all the years of work done by David Cameron to detoxify the image of the Conservative party on the issue of health, and separate himself from the Thatcherite legacy of the 1980s, it would seem sensible for his Parliamentary colleagues to point out that this Bill would set back that progress and confirm public fears that this is another instalment of privatisation.

I welcome your comments on the points above, and on your likely future stance  on these issues in Parliament.

Yours sincerely