Second reading of NHS bill offers a second chance to kill it


With the health and social care bill returning to the House of Lords for its second reading this Tuesday, the fight to prevent its passing is building. Following the publication of a letter signed by 400 public health experts against the bill, two new websites have been launched, one by the TUC and one by a grassroots activist, both dedicated to an action largely unknown in British politics: direct lobbying of peers. The TUC’s campaign, Adopt a Peer, aims to connect campaigners to a random peer, to start a conversation. The Guardian reports:

The thinking is that peers have no constituents and are unused to being lobbied in this way, and therefore are more likely to heed the writer’s concerns. The adopters are being encouraged to write a personal letter, developing a “relationship” with the peer.

At the same time, and apparently independently, a similar tool has been launched by an unnamed programmer. Peer Pressure focuses its efforts on cross-bench and Liberal Democrat peers, and, taking a cue from They Work For You, encourages those who have written to report back on how their chosen peer responded. This way, those peers who need extra persuasion can be identified and focused on, without hundreds of letters being sent to Lords already clear in their opposition.

Also this week, two stories have risen, one of which highlights just what the risk is from increased private sector involvement in the NHS, and the other demonstrates how to fight it if the bill does pass.

The first story was picked up by the mailing list NHS Managers, and details a letter sent to patients of a GP’s practice in York, which explains:

“…we are holding your details on a list of patients who require a minor surgical procedure that is no longer paid for by the NHS… as a result I am writing to make you aware of the options…”

The options then provided, of course, are essentially just one: go private.

We should be careful to be clear about what this story actually represents. It is not, contrary to other reports, the first blow in the war against a free at the point of access NHS; instead it seems to be merely an unscrupulous practice attempting to up-sell patients to private practice. When Ben Goldacre reported this story, he was inundated with similar tales happening all across the country.

What this does represent is the natural extension of private involvement in the healthcare system. There is nothing evil about businesses trying to up-sell; it is what they are built on. “Would you like to insure your MacBook?”; “Small, medium or large?”; “You want fries with that?” – this is the bread and butter of private enterprise. But when it is introduced into healthcare, it creates a set of dangerous incentives.

Under the proposed introduction of GP’s commissioning consortia, the people who make the decisions about which procedures to provide free on the NHS will be the same ones who stand to profit if their patients are forced to go private. As Chris Newdick, of the University of Reading, explains (pdf), the commissioning consortia themselves will be subject to the Nolan principles, including the principle of selflessness, but there is no clairity as to whether the same rules apply to GPs themselves. If not, they will have worrying freedom to profiteer at patients’ expense.

There is hope beyond the Lords, though. The Guardian reports of a campaign in Gloucestershire which has managed to prevent the privatisation of its healthcare system:

Michael Lloyd does not look like the sort of activist to cause a government-backed reform of the NHS to stop in its tracks. A stooped figure, clad in his worn Sunday best, the 75-year-old former railway worker has launched a legal challenge to the transfer of 3,000 NHS staff and nine local hospitals in Gloucestershire to a social enterprise.

Lloyd found himself at the sharp end of a national debate after signing a petition against the proposed transfer. Like many residents of the county, he knew nothing of the proposal to take community health services – and a £100m budget – out of the local health service and into the hands of Gloucestershire Care Services (GCS), a community interest company spun out of local primary care trust NHS Gloucestershire.

Lloyd’s legal challenge asserts that the changes “would be highly detrimental to the NHS services” he receives, says Rosa Curling of the law firm Leigh Day, which is representing him. “We looked at what the trust had been doing in relation to that transfer and found that they hadn’t complied with their legal duties,” she says. “The trust has a duty to undertake a proper, transparent and full procurement process.”

The rally and march in Stroud at the end of September drew several hundred protesters. As news of the legal challenge spread, what had promised to be a no-hope attempt to stave off the transfer took on a celebratory air.

The legal challenge has left Gloucestershire NHS and the putative social enterprise scrambling. Plans to implement the handover on October 1 were scrapped as a legal response was formulated.

This shows that if the bad bill does take a step closer on Tuesday to becoming a bad law, hope is not lost. We must not stop fighting until the future of the NHS is assured.

See also:

Can Lansley be trusted with the NHS? 400 more experts say NOShamik Das, October 4th 2011

Lib Dem MP tells Lords: How the NHS bill needs to be changedAndrew George MP, September 21st 2011

Lib Dem activists face reality about their MPs’ NHS visionTrevor Cheeseman, September 20th 2011

The two faces of NHS reformTamasin Cave, September 7th 2011

Cameron’s fantasy list of NHS reform backersShamik Das, September 7th 2011

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