Tuesday January 10 2012: IMMEDIATE RELEASE
Lansley’s NHS market could wind up like social care
While David Cameron and ministers talk misleadingly about “integration” of services for older people, the real danger is that the shambolic state of elderly care could be replicated across the whole of the NHS if Andrew Lansley’s controversial Health and Social Care Bill is rubber-stamped by the House of Lords.The Bill would fragment and “dis-integrate” the NHS: but the disintegration of social care has been taking place over the last 20 years. And the threat is that NHS care which is now free at point of use could be “integrated” with the failed social care system, which levies extensive means-tested charges – killing off the NHS as we know it.
Recent reports by Age UK and the King’s Fund on the crisis in elderly care have shown that 800,000 frail older people today are lacking services they need, rising to 1 million by 2015, while the Local Government Association recently warned ministers that the system of high-cost social care is “not fit for purpose”. BBC reports have exposed a growing problem of “bed blocking” and now hospitals are under pressure to discharge elderly patients despite the inadequate arrangements to care for them thereafter.
This competitive market in social care was created 20 years ago in sweeping “reforms” initiated by Margaret Thatcher. Until 1993, NHS hospitals were responsible for much long-term care, delivered free to all at point of use, funded from taxation, while those needing nursing home care had their fees covered by social security.
Now, with most NHS specialist elderly care beds having closed, and social care delegated to local government social services, patients are left dependent on costly, largely privatised domiciliary care, and privately-run residential care and nursing homes ” – while many more frail older people are excluded from any support by arbitrary “eligibility criteria” operated by cash-strapped councils facing 28% cuts over 3 years, and by local Primary Care Trusts. Elderly care is under-funded, fragmented, uneven, unequal and unsatisfactory, with responsibility split between local health and council commissioners, while 80% of domiciliary care is now privatised, and many care homes are run for private profit.
In this “market” vulnerable people are forced to “choose” between a multiplicity of low quality providers, who cherry-pick certain services and ignore others, leaving gaps in care. Pay and conditions for staff are notoriously poor, contributing to a demoralised, perfunctory service and the neglect of vulnerable people.
Competition has not brought improvements but has added new problems: elderly care is marked by poor contract management, sloppy and/or partisan commissioning, loose standard-setting, inadequate inspections, and rising charges as the remnants of public provision are replaced by a burgeoning private sector. And while the profits remain in private hands, any failure by private providers – such as the private equity firm that bankrupted the Southern Cross nursing home chain – lands back on the public sector, which has to step in and rescue the victims. The social care system is already becoming little more than a bare-bones service for the less well-off, with massive local variation and widening health inequalities. A similar fate is likely to befall the NHS if the current changes are implemented.
Mr Lansley’s plans for the fragmentation of the NHS involve disbanding its existing organisational structures, and rather than replacing them, turning over service coordination to the market’s “invisible hand”. The plans are devoted to opening up much greater involvement of private companies to deliver services paid for by the taxpayer; they include denationalising NHS hospitals as fast as can be managed. This threatens to fundamentally change, undermine and destabilise the health service.
The new system would be as poorly regulated, as patchy and incomplete, and as much of a postcode lottery as social care. It would allow private medical corporations or “any qualified provider” to scoop up profits – but dump all of the complex and costly cases onto publicly funded hospitals, for as long as such organisations exist. It would even allow local Clinical Commissioning Groups to designate some services as outside the NHS, making them subject to fees and charges for the first time since 1948.
London GP Jonathon Tomlinson said:
“If you want to know what a market in health care would look like, just look at elderly care – or dentistry, where charges are rampant, the private sector rules the roost, and many people cannot find an NHS dentist. Now GPs see many patients with dental problems. The NHS leads the world in fair access to care: Lansley’s Bill would undermine that.”
Lancashire GP and BMA Council member Dr David Wrigley adds:
“Our NHS was making real progress before Andrew Lansley’s Bill, and recognised as one of the best in the world: the danger is that it could become as unfair and chaotic as care of the elderly.”
Mr Lansley has the support of only a tiny minority of GPs and doctors for his Bill, which was not put before the electorate last year. His plans have been actively opposed by health workers and criticised by a wide range of think tanks and pressure groups for patients. Now a succession of feel-good government “initiatives” and announcements are being used as red herrings to divert the media and public while this retrogressive legislation is forced through the House of Lords.
That’s why David Cameron is now suddenly declaring himself an expert on nursing rotas and prattling about improved standards even while thousands of nursing jobs and support staff are axed, wards closed and services rationed.
Campaigners will be fighting on to try to prevent Lansley’s Bill reaching the statute book, including hospital consultant and BMA Council member Clive Peedell who is staging “Bevan’s Run” from South Wales to London His route starts at Bevan’s birthplace in Cardiff today (January 10), passes through David Cameron’s Witney constituency on Friday the 13th, and ends in a bedpan race down Whitehall on the 15th. There will be rallies at each staging post: why not join Clive and colleagues for your nearest rally, or even for the run? http://bevansrun.blogspot.com/p/details-of-run-with-maps.html
Dr David McCoy firstname.lastname@example.org
Dr David Wrigley email@example.com
Dr Jonathan Tomlinson firstname.lastname@example.org
Clive Peedell email@example.com
Dr John Lister 07774 264112, firstname.lastname@example.org