Public health and the House of Lords

Dear Honourable members of the House of Lords,

As public health doctors and specialists from within the NHS, academia and elsewhere, we write to express our concerns about the Health and Social Care Bill.

The Bill will do irreparable harm to the NHS, to individual patients and to society as a whole. It ushers in a significantly heightened degree of commercialisation and marketisation that will fragment patient care; aggravate risks to individual patient safety; erode medical ethics and trust within the health system; widen health inequalities; waste much money on attempts to regulate and manage competition; and undermine the ability of the health system to respond effectively and efficiently to communicable disease outbreaks and other public health emergencies.

While we welcome the emphasis placed on establishing a closer working relationship between public health and local government, the proposed reforms as a whole will disrupt, fragment and weaken the country’s public health capabilities.

The government claims that the reforms have the backing of the health professions. They do not. Neither do they have the general support of the public.

It is our professional judgement that the Health and Social Care Bill will erode the NHS’s ethical and cooperative foundations and that it will not deliver efficiency, quality, fairness or choice. We therefore request that you reject passage of the Health and Social Care Bill.

Yours sincerely,

Approximately 400 senior public health doctors.

For the letter that appeared in The Telegraph yesterday and a full list of signatories click here and scroll down

Editorial in the The Telegraph

Excellent comment piece in The Telegraph by David McCoy, one of the authors of the letter.

Guardian report “Experts including 40 directors of public health say government’s health and social care bill will cause ‘irreparable harm'”

BBC news report, “NHS changes to cause irreparable harm”

One of the authors, Professor Martin McKee CBE exchange of views with Andrew Lansley on BBC London: (starts at 8.40 mins)

ITN news


Lord Owen explains why he is demanding that the Government put parts of the Health and Social Care Bill through a select committee in the House of Lords.

(From Politics Home)

The House of Lords is a revising chamber for legislation and the massive Health and Social Care Bill presents a major challenge to the Lords on how to fulfil that role. The adversarial government/opposition voting on amendments on the floor of the House is the traditional method of revision. But as the House of Commons has already shown that method is not sufficient for a Bill as controversial, as large and as complex as this one. Fortunately the House of Lords has a precedent whereby a Bill, or part of a Bill, can be referred to a Select Committee and therefore I have tabled today an amendment as follows:

The reason for referring parts of the Bill to a Select Committee are well illustrated if we examine the changes relating to the duties of the Secretary of State for Health. In this Bill they are changed and many lawyers believe substantially reduced. Yet at the same time the Bill establishes a massive new Quango – the NHS Commissioning Board. Sensible people can accept that in any decentralisation of power there has to be a measure of managerial freedom but equally, sensible people will feel that the Secretary of State and Parliament has to have special powers, some of them probably new powers, to deal with this situation. This complex area of democratic control and decentralisation must lie at the core of House of Lords scrutiny and few would deny that a Select Committee, able to hear evidence with their own Parliamentary draughtsmen and empowered to return that section of the Bill to the floor of the House of Lords in an amended form for their consideration, is the most powerful way of proceeding. To ensure that this is not seen as a blocking mechanism the motion instructs the Select Committee to report back on these Clauses referred on part 1 of the Bill by the time the House resumes after Christmas on 10 January 2012 and we have also instructed that all the clauses referred to the Select Committee should be reported back to the House before the end of February. It is perfectly possible if agreed to commence discussion in parallel on the floor of the House on the selection of amendments of those parts of the Bill that are not referred to the Select Committee.

Another example of matters referred to a Select Committee is Monitor. This is an existing organisation that is about to be transformed. Is it really acceptable that the bulk of the powers of this Quango should be introduced by Regulation and not put into the substance of the Bill? Again, the complexity of its new definition of its powers, only conceded a few weeks ago, need to be reappraised and judged as a whole – something far better done initially by a Select Committee and then returned to the floor of the House.

The House of Lords is a pragmatic grouping of men and women, many of whom in various ways have considerable knowledge about the NHS. The commissioning proposals have already controversially been largely introduced following Second Reading in the House of Commons. Many people feel now that this is fait accompli and since they have been revised by the Forum process, there is a need within the NHS for the Lords to establish clarity after due consideration.

For that reason we have not sought to delay debate on these matters on the floor of the House, nor on Trusts hospitals. Indeed over 64% of the Health and Social Care Bill will under this amendment proceed in the traditional way on the floor of the House. It is also clear that what we are proposing is not a blocking mechanism in that we specifically instruct the Select Committee to report as early as 10 January 2012, when the House resumes after the Christmas Recess, on those Clauses in Part 1 which relate to the duties of the Secretary of State and before the end of February on all the remaining Clauses.

We will be discussing the wording of the amendment between now and 10 October when it has to be in its final form to see if the Select Committee deliberations can be brought forward in any way. The terms of the amendment it is open to the Select Committee to report earlier if this is feasible.

Lord Rea (an ex-GP) promises to table amendments to ‘wreck the health bill’ Pulse.

What you can do:

Adopt a Peer. Use this to be allocated a Peer and write to them about the health bill. (I used this and wrote to Lord Haskins and received a hand-written reply)

Peer Pressure. Use this to contact libdem and crossbench peers to vote against the health bill

If you are a member of any of the other professional colleges, GPs, physicians, surgeons, etc. a similar letter would send a very strong message to the peers.

4 responses to “Public health and the House of Lords

  1. JT – Dr No doesn’t for a moment think we shouldn’t lobby peers – it needs to be done – but he is not over-hopeful of a useful result. He suspects the whole exercise will turn out a bit like the laxative that didn’t work…so he thinks we need a Plan B.

    DN’s proposed Plan B, you will be glad to hear, does not involve manual evacuation, but it may turn out to be equally difficult and possibly just as unpleasant. It involves recognising that the only people who really have the power to tank the bill are rank and file GPs. And the reason it may turn out to be difficult, even unpleasant, to get these GPs to wake up and stand up to the bill is because, as a bunch, our profession is rather inclined to indolence and indifference – as happened with MMC/MTAS. DN just hopes we’re not going to make the same mistake again…

    PS have dual posted this comment on JT/Dr G’s blogs for all the obvious reasons.

  2. From The Guardian 3rd October 2011
    The Department of Health said:

    “A group of the country’s top doctors and NHS experts have already analysed the health bill and we have accepted all their recommendations to improve it. Many GPs and other doctors have also already spoken out in support.”

    Why does the D. of H. and the Government persist in ignoring the medical profession and the general public?? What will it take before they listen?

  3. Lord Rea has tabled an amendment to the bill calling for its rejectiono by the Lords. This is on the grounds that it specifically contravenes the coalitionn agreement, though there are large numbers of more specific reasons for its rejection.

    Anyone contacting a peer or two via the TUC or 38 degrees might like to include a reference to Lord Rea’s amendment and asking him or her to support it and thus save the NHS fromm desctruction.

  4. The lib dem Lords I have contacted seem to be very strongly adhering to the coalition line. At this point It is going to take a miracle.

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