Prime minister wrong to claim we support Health Bill, say public health experts
In defence of the NHS: why writing to the House of Lords was necessary
The prime minister was wrong to claim we support Health Bill, say public health experts in this week’s BMJ.
Last week over 400 public health doctors, specialists, and academics from across the country wrote an open letter to the House of Lords stating that the Health and Social Care Bill will do “irreparable harm to the NHS, to individual patients and to society as a whole,” that it will “erode the NHS’s ethical and cooperative foundations and that it will not deliver efficiency, quality, fairness or choice.”
The prime minister claimed that the letter actually supported aspects of the Bill, while the secretary of state was dismissive, maintaining that people signed it without reading it, and that it was “politically motivated” and unsupported by “a shred of evidence.”
These claims were wrong, argue leading public health experts today.
There was no qualified support for the Bill, they say. Nor did signatories write in a political capacity; they wrote in their professional capacity and with the public interest in mind. Nor are public health professionals alone in having concerns: the public, the BMA, and many of the royal colleges continue to express deep and continuing concerns.
There are many problems with the Bill, they warn, such as abolishing direct accountability of the secretary of state to secure comprehensive care for the whole population and the mechanisms and structures for securing that duty. The Bill will also usher in a new era of commercialisation, they add, handing over a greater control over public budgets to the dictates of the market.
“We believe that the majority of healthcare professions reject this proposed transformation; and are aware of the clinical, professional, and ethical shortcomings of market based health systems such as those that exist in the United States,” they write.
They conclude: “The secretary of state has called for a debate based on evidence. We agree. But this requires transparency about the evidence base and the intentions that have shaped the Bill. So far, the proposed structures do not conform to the goal of a universal and equitable health service, free at the point of delivery and accessed on the basis of need and not ability to pay.”
As doctors in England, we are writing to express our conviction that the Health and Social Care Bill will irreparably undermine the most important and admirable principles of the National Health Service, and to appeal for its rejection by the House of Lords.
Because it is universal and comprehensive, and publicly accountable, and because clinical decisions are made without regard for financial gain, the NHS is rightly regarded all over the world as the benchmark for fairness and equality in healthcare provision.
The transfer of services to private, profit-making companies will result in a loss of public accountability and a damaging focus instead on low-risk areas that are financially profitable. A confused patchwork of competing providers will deliver a fragmented and inequitable service, and any reliance on personal health budgets or insurance policies will increase inequality.
Because there will be a financial incentive for providing treatment, patients will be over-treated, the potential costs of which are limitless. The possibility of the commissioning role being outsourced to the private sector is also of deep concern.
In forcing through this ill-conceived Bill, without an electoral mandate and against the objections of healthcare professionals, the Government is also ignoring overwhelming evidence that healthcare markets are inefficient and expensive to administer.
The public has been misled by claims that no major reorganisation of the NHS would be undertaken, by repeated denials that what is happening represents privatisation, and by suggestions that the Bill enjoys the support of the medical profession. We do not accept that “things have already gone too far”. The enactment of some of the Bill’s proposals has been premature and possibly unlawful, but some of its most damaging aspects may still be mitigated. We believe that on moral, clinical and economic grounds, the Health and Social Care Bill must be rejected.
Dr Jonathan Folb
Consultant Microbiologist, Liverpool
Dr Clive Peedell
Co-Chair NHS Consultants’ Association and Member of BMA Council and Political Board, Consultant Clinical Oncologist, Middlesbrough
And more than 1,000 others. Click here to see the full list of signatories.
Sir, We write as paediatricians and child health professionals in the NHS, academia and NGOs to express our concerns about the Health and Social Care Bill.
Peter Connolly (“Baby P”) died because too many unco-ordinated and fragmented services, staffed by too few and inexpert staff, were involved in his care. The current proposals designed to increase provider plurality will amplify these deficits.
Children and young people are especially susceptible to the heightened commercialisation and marketisation ushered in by this Bill. The inevitable fragmentation of NHS services will undermine our abilities to protect children at risk from neglect and abuse, and compromise the care of children with serious illnesses.
We are concerned that moving public health further from the front-line NHS jeopardises our ability to continue improving children’s health services. And we are alarmed by the influence of commercial industry on public health policy-making, which diminishes our efforts in tackling child health determinants such as obesity.
The Health and Social Care Bill will be bad for child health and children’s services in the NHS. The Government claims that the reforms have the backing of the health professions. They do not.
It is our judgment that the Bill will erode the NHS’s ethical and co-operative foundations and that it will not deliver efficiency, quality, fairness or choice. We urge the House of Lords to reject this Bill.
Professor Sir Al Aynsley Green; Professor Stuart Logan; Professor John Warner; Professor Neil Marlow; Dr Ingrid Wolfe; Dr Simon Lenton; Dr Sara Hamilton; Dr Aasif Khan; Dr Agnes Lakner; Dr Alan Gibson; Dr Alasdair Bamford; Dr Alexandra Pledge; Dr Alexandra Smith; Dr Alice Rouche; Dr Alison Mott; Dr Amanda Cundy; Dr Amanda Dauncey; Dr Andrew McArdle; Dr Andrew Robins; Dr Angela Hume; Dr Anil Gupta; Dr Anna Baverstock; Dr Anne Aukett; Dr Anne Mason; Dr Anne-Lise Goddings; Dr Anthony Kaiser; Dr Atul Gupta; Dr Avril Washington; Dr Barbara Golden; Dr Basu Roy; Dr Beatrice Cooper; Dr Belinda Bateman; Dr Billy White; Dr C. Harikumar; Dr Caroline Bodey; Dr Catherine Clapton; Dr Catherine Pattinson; Dr Cathy Troupp; Dr Charlotte Elder; Dr Charlotte Wattebot O’Brien; Dr Chloe Johnston; Dr Chloe Macauley; Dr Christine Duval; Dr Claudia Gore; Dr Cliona Ni Bhrolchain; Dr C.P. White; Dr Craig Knott; Dr David Bennett; Dr Debbie Sell; Dr Deborah Christie; Dr Deborah Hodes; Dr Dibble; Dr Dieudonne Birahinduka; Dr Dougal Hargreaves; Dr Ewoud Bos; Dr Ezam Mat Ali; Dr F. Leah; Dr Fawzia Rahman; Dr Feuchtwang; Dr Fiona Hampton; Dr Fiona Hikmet; Dr Fionnghuala Mills; Dr Gareth Penman; Dr Gary Ruiz; Dr Gill Gorell Barnes; Dr Gill Turner; Dr Gopinathannair Harikumar; Dr Hanna Erickson; Dr Hannah Baynes; Dr Harry Egdell; Dr Heather Mackinnon; Dr Helen Bantock; Dr Helen Bedford; Dr Helen McCullagh; Dr Helen Palmer; Dr Hilary Klonin; Dr Hilary Wyatt; Dr Hoong Wei Gan; Dr Huda al Hadithy; Dr Hugh Stewart; Dr Ian Male; Dr Indrani Banerjee; Dr Intan Yeop; Dr Jan Welbury; Dr Jane Haley; Dr Jane Hassell; Dr Jane Hume; Dr Jane Lyons; Dr Jane Ritchie; Dr Jane Simpson; Dr Jane Teper; Dr Janet E. McDonagh; Dr Jayanta Banerjee; Dr Jeff Debelle; Dr Jethro Herberg; Dr Jeza Salvo; Dr Jill Painter; Dr Joanne Beckman; Dr Johanna Reed; Dr John Hutchins; Dr Joia de Sa; Dr Jonathan Wyllie; Dr Julie Wilson; Dr Juliet Penrice; Dr June Thoburn; Dr Karen Ansell; Dr Karen Horridge; Dr Karl Rakshi; Dr Kathy Hawley; Dr Kelsey Jones; Dr Kerry Robinson; Dr Kim Holt; Dr Kirsty LeDoare; Dr Kumudini Gomez; Dr Lally McDermott; Dr Lauri-Ann Van der Poel; Dr Lee Hudson; Dr Linda Alderson; Dr Lingan; Dr Louisa Draper; Dr Lucy Aldridge; Dr Lynsey Bennett; Dr Maggie Bruce; Dr Malgorzata (Gosia) Radomska; Dr Mando Watson; Dr Mandy Rose; Dr Manish Sinha; Dr Maria Bredow; Dr Mark Bagott; Dr Mark Hunter; Dr Mary Gainsborough; Dr Mary Rudolph; Dr Matthew Thompson; Dr Max Davie; Dr Melanie Parker; Dr Mervyn Loi; Dr Michael Quail; Dr Mike Kidd; Dr Mitch Blair; Dr Nagendra; Dr NagulanThevarajan; Dr Naomi Breese; Dr Naomi Richman; Dr Naomi Webber; Dr Natasha de Vere; Dr Neal McCathie; Dr Neeta Patel; Dr Nick Finer; Dr Nick Lessof; Dr Nicola Cleghorn; Dr Nicola Morgan; Dr Nicole Horwitz; Dr Nigel Speight; Dr Nkem Onyeador; Dr Olie Chowdhury; Dr Pam Zinkin; Dr Patrick Oades; Dr Paul Carter; Dr Paul Farrant; Dr Paul Gringras; Dr Penny Gibson; Dr Peter Erhardt; Dr Peter Lachman; Dr Peter Poore; Dr Peter Sidebotham; Dr Philip Ind; Dr Philip Minchom; Dr Prabhat Gupta; Dr Quentin Spender; Dr Rachel Brocklebank; Dr Rachel Howells; Dr Rajendra Mahendrakar; Dr Raoul Blumberg; Dr Rashnik Ghalay; Dr Raymond Brown; Dr Renuka Dias; Dr Richard Tomlinson; Dr Rod Skinner; Dr Rossa Brugha; Dr Sam Behjati; Dr Sarah Eisen; Dr Sarah Morris; Dr Saul Kaufman; Dr Sebastian Kraemer; Dr Seema Sukhani; Dr Sharma; Dr Sharon D’Souza; Dr Sharon Taylor; Dr Sim; Dr Simon Wilkinson; Dr Sophie Khadr; Dr Stefania Vergnano; Dr Stephanie Kirk; Dr Stuart Murray; Dr Susan Allen; Dr Susan O’Halloran; Dr Susie Minson; Dr Tagore Charles; Dr Therese Bennett; Dr Thomas Day; Dr Timothy Watts; Dr Tony Waterston; Dr Tracy Ellenbogen; Dr Tristan J. Barber; Dr Tukmachi; Dr Vinthagen; Dr W.H. Lamb; Dr Wren Hoskyns; Dr Wynne Leith; Dr Ximena Poblete Qasim Chowdary; Mr Colin Dyer; Mr John Beavis; Mr Mark Carter; Mr Shlobaln Corsle; Ms Angela Lewis; Ms Annie Souter; Ms Carol Graham; Ms Carol Jones; Ms Carolyn Young; Ms Christine Bidmead; Ms Christine McDermott; Ms Christine Okeeffe; Ms Dolores D’Souza; Ms Emma Kardani-Zadeh; Ms Fiona Henley; Ms Fiona Napier; Ms Freda O’Driscoll; Ms Geraldine Walsh; Ms Helena Jenkins; Ms Janine Hackett; Ms Jean Troughton; Ms Jenny Pedley; Ms Lindsay Hamilton; Ms Lizzy Marks; Ms Lucy Hinds; Ms Maggie Fisher; Ms Rachel Pailes; Ms Rebecca Mortimer; Ms Sarah Cooper; Ms Susan Knights; Ms Vasu Shah; Professor Alan Emond; Professor Allan Colver; Professor Ed Peile; Professor Elisabeth Paice; Professor Imti Choonara; Professor John Wood; ProfessorSarah-Jayne Blakemore; Professor Shakeel A, Qureshi; Professor Stephen McMahon; Sir Terence English