A well-attended public meeting at Whaley Bridge Bowling Club on Thursday called on Andrew Bingham to take back to the Government the serious concerns of constituents about the effect that the Government’s reforms will have on the NHS.
Over 80 people went along to the meeting organised by Whaley Bridge Labour Party in response to mounting public concern locally that the Health & Social Care Bill going through Parliament will lead to increasing privatisation, longer waiting times for NHS patients, and lower standards of healthcare.
Andrew Bingham came on to the meeting after attending a prior engagement. In the meantime, expert speakers set out the changes that the Bill would make and the effects it would have.
Professor Stephen Harrison, who has recently retired as director of a health policy research team at the University of Manchester, explained that the Bill would ban ‘anti-competitive’ behaviour, making it much harder for doctors in different areas of the health service to collaborate to deliver the best quality care for patients. He was also concerned that the widespread use of private providers would increase costs in the long run. The current changes to the NHS were hasty and poorly planned; “In over 35 years of studying healthcare, I have never seen a shambles like this one.”
Dr Greg Carter has been a GP in Marple for 12 years. He was worried about the proposed increases in private companies in the NHS, “Private provision of medical services has increased over the last 5 years. It is often expensive, sometimes unnecessary and not always as good quality as the NHS.” On GP commissioning, Greg de-bunked the myth that GPs could make a lot of money out of commissioning, but said that the perception that this was possible could break down the trust of patients in their GP. If people felt that their doctor was not referring them for tests or treatment that they thought they needed because this would save the doctor money, they would lose their faith in their GP and we would all lose a lot from our health service if this happened.
Paul Foley, the UNISON organiser for health staff in the North West, stood up for the so-called ‘bureaucrats’ in the NHS, criticised in a statement from Andrew Bingham. These behind-the-scenes staff are experts in administration, finance and medical records who work hard for the NHS and enable doctors and nurses to focus on delivering care. Paul was concerned that the Bill stipulated that GPs would have to put almost all health services out to tender from ‘any willing provider’ which would lead to much more involvement by private companies whose primary duty is to maximise profits to shareholders, not to make people well. The Bill would also remove the cap on income that hospitals could receive from private patients. This would be an easy way for hospitals to make the ‘efficiency savings’ they are being asked to, but would lead to growing waiting times for NHS patients.
All the speakers agreed that although the Government has announced a ‘pause’ in the legislation to enable them to listen to the concerns of professionals, on the ground the reforms were continuing apace in spite of increasing problems and large numbers of good staff leaving.
Andrew Binghamthen set out that although he “was not an expert in health care” and had not yet had time to read the Government’s Bill, he did not believe the reforms would lead to privatisation of the NHS ‘by the back door’, but to a widening of the use of private companies in the NHS. Andrew wants to encourage this to create cost savings which can be re-invested in more treatments and better patient care.
He felt that giving GPs the power to allocate their own budgets would directly benefit patients and allow GPs to respond more effectively to localised issues.
Andrew welcomed the Government’s pause in the legislation as a “genuine listening exercise” and said that he would be meeting with local GPs to get their thoughts. He also invited concerns from constituents which he would take back to Westminster, although he did say that “I don’t foresee wholesale changes to the Bill.”
Members of the audience tackled Andrew about why the Government has proceeded with these reforms after promising no more top-down reorganisations being imposed on the NHS, about the lack of accountability of GP consortia, and the forcing of competition into health services, as well as concerns about how vulnerable patients with special needs or mental health problems would fare under the new system.
Mr Bingham acknowledged that there were genuine concerns about some aspects of the Bill. He asked for more information and views from constituents who he encouraged to write to him. He would write to ministers and send all correspondents a copy of what he was saying to them. He concluded, “I am not saying I will definitely vote for the Bill” but would await any changes that the Government make to it before deciding whether or not to support it.
Fiona Sloman, chair of High Peak Labour Party, who chaired the meeting, was pleased with how it went,
“There is a lot of concern about the health reforms locally, and people found it very useful to have these complicated proposals explained clearly, with the implications set out. I am glad that Mr Bingham came along to hear the views expressed and offered to take the serious concerns back to government ministers, although I find it very worrying that our MP has voted for this important Bill at Second Reading without having read it! We will certainly continue to press to ensure that these damaging changes are not imposed on the NHS and I would urge anyone with concerns about the Bill to write to Mr Bingham to let him know the views of his constituents.”
Questions for Andrew Bingham MP on the Health & Social Care Bill
1. Enforced Competition
A powerful new economic regulator will be created in the NHS to promote and guarantee competition between health service providers. The NHS will be open to challenge from UK and EU competition laws. Once introduced, this may be impossible to reverse in future. In a rural area such as High Peak or in specialist services there will be little competition and no incentive to improve services.
What means will there be to ensure continued quality and improvement of services even in rural areas and in specialist services?
2. Competition enshrined in the Bill will prevent essential collaboration
Applying Competition Law to health services and the strict guidelines in Section 2 of the Bill will make it difficult for GPs, hospitals and other providers to collaborate to ensure joined-up services and to drive up standards by spreading best practice. The Bill leaves GPs and providers who to work in this way open to challenge by private healthcare companies on the grounds of uncompetitive behaviour and healthcare staff vulnerable to being subpoenaed to give evidence to the Regulator.
Section 2 of the Bill on Competition needs to be amended to ensure that collaboration between service providers and GPs and the spreading of best practice is not only allowed but positively encouraged.
3. End of limit on private care in NHS hospitals
Limits on the use of NHS hospital beds and staff to treat privately paying patients will be removed. There is no provision for monitoring the impact on NHS services, or a need to show that increasing private income will not harm care for NHS patients. It could lead to NHS hospitals focusing on the more profitable private health service provision, at the expense of access to and/ or quality of NHS care. Therefore more patients will go private to escape worsening NHS services, so NHS providers prioritise private patients, which further worsens NHS services.
What provision will there be for monitoring the impact on NHS services of increased private health service provision, now that waiting time targets have been abolished?
What measures will be put in place to ensure that hospitals do not lessen the amount of required NHS care due to increased private patients?
4. Hospitals that go bust will close and services suffer
Intervention in NHS hospitals that are financially struggling will not occur until they reach the extreme of insolvency. The court appointed administrator will make decisions on financial grounds without consideration for patient services and safety. Services that are not designated as essential could be shut down with no consultation or oversight.
How can hospitals be rescued from insolvency in time for them to recover and continue to provide services needed by local people, if the NHS is to be covered by Competition Law?
If an administrator is appointed, who will represent the health needs of local people and how will these be prioritised?
5. There is still scope for competition based on price (in spite of amendments)
The Bill has been amended to refer to ‘price’ rather than maximum price, which ostensibly precludes price competition, and is the basis of the government assurances that competition will be on grounds of quality only. However, this would require absolutely every kind of care and intervention, service and patient ‘pathway’ to have an established tariff. (At present only about 60% are covered by a tariff.) This represents either an impossible bureaucratic task for the regulator, Monitor (which would need to set thousands of prices) or would require some arrangement to determine local tariffs/ prices. If the latter occurs, there would be no reason to expect all local prices for a given intervention to be the same, which implies at least the possibility of some sort of price competition.
How will the government ensure there is no competition based on price?
6. The Dual Role of GPs
Responsibility for planning, negotiating, managing and monitoring health services will be transferred to consortia of GPs. GPs’ dual role threatens the relationship of trust with patients. GPs will no longer just be advocates for patients’ health, but also the people making rationing decisions on their care. GPs could benefit financially by keeping costs down through not referring patients to hospitals for necessary tests or treatment. Other than for emergency care, patients are supposed to have free choice of secondary care provider (and indeed of actual consultant). Thus even if there were price competition, GPs could not force patients to choose the cheapest provider. Therefore a GP consortium seeking to save money would probably have the best chance of doing so by changing its members’ prescribing and referral behaviour, and by substituting care in primary settings for care in hospital. (If there’s no referral, the patient has no choice of provider.)
How could patients know for sure that a GP was not referring them to a secondary care provider for clinical reasons rather than to save the consortium money?
7. Conflicts of interest for GP Consortia and private companies
GPs will probably extend the range of services that they offer so they could themselves provide (and be paid for) services moved out of hospital, giving a conflict of interest. They will also need help from private companies with commissioning. These companies may be able to buy services provided by another arm of the same company. Again, a conflict of interest would occur.
How can GP consortia avoid conflicts of interest from they and their commissioning companies both commissioning and providing services?
8. Lack of Planning
GPs will need to commission services for rare and complex conditions that they rarely see and may struggle to have expertise across the whole range of services required. Primary Care Trusts and Strategic Health Authorities that previously coordinated and collaborated to improve health services across areas will be abolished, and Health and Wellbeing Boards created. These Boards will have no authority over GP consortia or providers, and will not be able to enforce the kind of collaboration needed to make efficiencies and improve the health service. It risks a total lack of planning where patient care will suffer. The King’s Fund have said, “The powers granted to Health and Wellbeing Boards are weak and there is a risk that health and social care integration may be more difficult to achieve.”
How can the role of planning health services across large areas and a vast range of services be improved to take up the essential roles provided by PCTs and SHAs?