My predictions for the future disintegration of the NHS

Yesterday the health and social care bill was made law. So what are my predictions for the future of our beloved NHS? 

• In the short-term there will be a vacumn of authority as the old system devolves power to GPs who are learning on the job. I predict there will be a flurry of contracts awarded to private companies to take control of local commissioning and health services as GPs struggle with the enormity of the challenge imposed upon them

• In the medium-term integration between departments and hospitals will begin to splinter as hospitals concentrate on pulling punters into their doors in order to 'win' funding from GPs. (For example from my own experience Chelsea & Westminster hospital send their doctors to Brompton hospital to enable joint consultation for CF patients who also have liver disease. I can imagine such arrangements ending due to funding complications.)  

Waiting lists will rise as services try to stick to budgets by rationing care and maximising the number of private patients they treat. The bill allows up to 49% of work at NHS hospitals to be given over to private patients.

More and more obese people and smokers will find themselves denied services as GPs find any excuse to limit care in order to meet spiralling costs. 

National scandals will arise in which private health companies are accussed of patient neglect and care as they cut services in order to make a profit. This has already happened under Bupa.  

• In the longer-term, we'll all get used to paying for some NHS services. I can easily imagine paying for evening and weekend doctors appointments as it'll be billed that you are buying the convenience of the time, not the service. 

It'll become routine to take private healthcare if you can afford it.

• In the very long-term the NHS will become a safety net only for those who have no private healthcare, and people will expect only the most basic care for it. 

As such the life expectancy gap between the rich and poor will continue to widen.

The health and social care bill is the worst thing this Government has done while in power, and Cameron and Clegg will be hated for it by future generations far more than Thatcher ever was for her deindustrialisation drive and war on the miners.

Today the NHS is dying. Cameron & Clegg will never be forgiven.

So let's mark this date in our calendars and tell our grandchildren. The NHS - that wonderful institution created after a war in which every family came to experience first-hand what it was to suffer and to lose loved ones -  is officially dying. Today, the Health and Social care bill became law.

• It allows private providers to cherry pick what services it provides leaving NHS to pick up the problem patients which don't present an easy profit (the Lib Dems have claimed they have amended the bill to prevent this happening but their amendment only demands that providers are transparent when they do cherry pick).
• It forces hospitals to compete against each other for funding meaning that they are at threat of unplanned closure if they don't get enough patients. It also promotes competition rather than integration of care which is what is needed to help better manage the prevention of long-term conditions such as diabetes and liver disease, two illnesses that are rising exponentially and are a massive drain on NHS resources.
• It allows up to 49% of work at NHS hospitals to be given over to private patients effectively doubling the waiting list for those people who can't afford private health insurance.
• The risk register, that the Government refused to release despite repeated demands to do so from the Information Commission, was leaked yesterday. It is thought to be an early draft but it clearly warns that the Bill could make the NHS unaffordable: "[A risk that ] design work proceeds without the confirmation of cost envelopes for each organisation which means that the future system design is signed off, and the Bill proceeds, without assurance that the whole system is affordable. One example of area where system could be more costly is if GP Consortia makes use of private sector organisations/staff which adds costs to the overall system". The document continues:: "[A risk that] Future efficiencies cannot be managed and driven through the system effectively, because there is no organisation to plan and manage holistic efficiency programmes. So there is a risk that costs of the future system cannot be controlled."

So what are my predictions?  

• In the short-term there will be a vacumn of authority as the old system devolves power to GPs who are learning on the job. I predict there will be a flurry of contracts awarded to private companies to take control of local commissioning and health services as GPs struggle with the enormity of the challenge imposed upon them

• In the medium-term integration between departments and hospitals will begin to splinter as hospitals concentrate on pulling punters into their doors in order to 'win' funding from GPs. (For example from my own experience Chelsea & Westminster hospital send their doctors to Brompton hospital to enable joint consultation for CF patients who also have liver disease. I can imagine such arrangements ending due to funding complications.)  

Waiting lists will rise as services try to stick to budgets by rationing care

More and more obese people and smokers will find themselves denied services as GPs find any excuse to limit care in order to meet spiralling costs. 

National scandals will arise in which private health companies are accussed of patient neglect and care as they cut services in order to make a profit. This has already happened under Bupa.  

• In the longer-term, we'll all get used to paying for some NHS services. I can easily imagine paying for evening and weekend doctors appointments as it'll be billed that you are buying the convenience of the time, not the service. 

It'll become routine to take private healthcare if you can afford it.

• In the very long-term the NHS will become a safety net only for those who have no private healthcare, and people will expect only the most basic care for it. 

As such the life expectancy gap between the rich and poor will continue to widen.

So as I say, mark this date in your diary. The health and social care bill is the worst thing this Government has done while in power, and Cameron and Clegg will be hated for it by future generations far more than Thatcher ever was for her deindustrialisation drive and war on the miners.

Budget 2012: the disabled marginalised yet again

Yesterday's budget contained a kick in the teeth for disabled people, quickly followed by a punch in the face.

The Chancellor's retreat on child benefit, moving the threshold for ineligibility from those earning over £43,000 to those earning over £60,000, was a bare-faced example of the Government looking after its own voters. When the planned benefit cut was announced last year there were howls of outrage amongst higher rate earners, and the Tories, mindful an election has to be fought in perhaps two years time, decided to try and save their own skins.

How is this relevant to disabled people?

When the recent Welfare reform Bill passed through the House of Lords, three defeats were enacted on the Government as the Lords chose to make changes that they believed would safe-guard some of the most sick and disabled in the country. One of those changes was to extend the length of time that people on contributory-based Employment Support Allowance could claim the benefit. The Government proposed that those people place in the Working Capability Group of ESA (so claimants who are too ill to work but should be able to in the future) could only claim the benefit for a year. The Lords voted to extend this to two years to ensure that people had enough time to get better before being forced into work. Macmillan cancer support for example argued that annually 7.000 cancer patients, routinely placed in the Working group of ESA, take longer than 12 months to recover.

Although the Lords followed due democratic process to enact these changes, they have not come into force. The Government used 'financial privilege' to block these amendments. In short, MPs cried "Sorry, no money!" and did so in a way that has seen no precedent.

But suddenly come budget day, the Government discovered a stash of cash to save the child benefit of higher rate tax-payers, those who are doing ok in life, and yet still no money to extend ESA for those who are too sick to work through no fault of their own. More worryingly for democracy, the Government places greater value on the opinion of its voters then on the democratic process of a Bill being passed into law.

The second fear hidden in the budget was Osborne's casual mention that Ian Duncan Smith would have to find a further £10 billion of welfare cuts on top of the £18 billion already slashed from these bills. The biggest slice of welfare is spent on old age - with today's vicious headlines about a granny tax I can't see the Government making any further cuts to pensioners. Child benefit cuts now seem completely off the table, a decision that Ian Duncan Smith may come to resent Osborne for as he frantically tries to cut £10 billion.

So where can more cuts be found? Housing benefit perhaps, childcare credits even, but a clear forerunner would be disability benefits. Disability Living Allowance is already scheduled to be scrapped next year, and replaced by Personal Independence Payments (PIP). In the Government's last spending review it arbitrarily decided to cut recipients of PIP by 20%, before it had even decided the criteria for eligibility or assessed the needs of a single disabled person.

What's the betting that in the next spending review the Government decides to save 25% or even 30% from the PIP bill? I for one am very worried.

What practical changes to Atos's WCA would you recommend to the Government?

The 'Responsible Reform' Spartacus report revealed the power of social media in helping to raise awareness to the cuts faced by disabled people in the UK. It got the House of Lords to listen to disabled people. If it wasn't for a the Government utilising the Commons 'financial privilege' in a way that has seen no precedent, significant changes would have been made to the Welfare Bill that would have protected disabled people from some of its worst 'reforms'.

So thinking about this success, and following on from the brilliant article written by Amelia Gentleman in the Guardian earlier this week, I thought it would be great to capture people's experiences of Atos's Working Capability Assessment (WCA) to pull together recommendations for the Government to help make the process fairer.

As much as many people reading this will say the WCA shouldn't exist, my main focus is to work within the system that has been imposed on us (and which no political party has recommended repealing) to think of practical changes that the Government could implement immediately and at no cost. Listed below are my initial thoughts. Please do comment and add your thoughts too.

1. DWP should give doctors' reports equal weight as Atos's WCA medical test
Although Atos conduct the 'independent' medical test it is the DWP who have the final decision about who does and doesn't receive ESA. It is widely felt amongst the disabled community that in reality the DWP are just rubber stamping the decision made by Atos's medical test, at it is the company's system of awarding points to a claimant's illness that decides if someone reaches the threshold of eligibility. A simple change would be to give equal weight to the reports given to the DWP by the claimant's own doctors and to the report provided by Atos. Where there is a clear discrepancy in the perceived ability of a claimant the DWP could step in early to demand more informationn from both parties, hopefully reducing the number of mistakes made and the huge cost to the Government of managing appeals against DWP's ESA decisions.

2. Stop the continual cycle of re-testing
One of the shocking problems within the ESA system, is that once a claimant has waited up to nine months to have his or her case heard at the court of appeal and finally been awarded ESA, they can be recalled for another medical within months of the appeal being heard. This second medical then strips the claimant of ESA forcing them back into the stressful and lengthy appeal process. This makes no sense to either the claimant who is struggling to regain their health or to the tax payer which is paying £50 million a year for this appeals merry-go-round. At each appeal hearing, each claimant should be given a date before which they cannot be called back for another medical and the DWP must be made to honour this date. I suggest a year before retests but opinions are welcome on this.

3. Impose financial penalties on Atos for incorrect decisions
A Commons select committee report last year highlighted that Atos may be driven by a profit motive to, in their words, "get the assessments done, but not necessarily to get the assessments right". The Government should treat Atos like any other private contractor and impose financial penalties for incorrect decisions. Clearly a margin of error may be acceptable but decisions in which a claimant has been awarded 0 points by Atos to then be awarded 15 points on appeal cannot be justified. It isn't in the taxpayers interest to fund an appeal process worth £50 million a year while letting Atos retain all of its £100 million annual fee.


Please do let me know what you think - it would be great to work together as a social media community to create key recommendations from those who have been through the WCA process to try and make a difference to those who have to endure it in the future.

C4 programme 'The Undateables' - Good or bad idea?

I saw today that Channel 4 are launching a new programme called 'The Undateables'. It basically sends people with a disability or impairment to a dating agency and tries to help them find love. Is this a good idea?

The blurb is already pretty unfortunate.

It says that the programme will follow "a range of people whose ability to form relationships is affected by an impairment or challenging condition - such as being deaf, or having Tourette's". I'm not deaf nor do I have tourettes but I wouldn't have thought either of those conditions has an impact on a person's 'ability to form a relationship' as that complicated emotional stuff about commitment and falling in love doesn't have much to do with whether you can hear clearly or not. 

I do have Cystic Fibrosis. I know that lots of CF people do worry about whether or not they will find someone to settle down with as it does take a very special person to say 'yes please' to all the crap that CF entails (including not reaching pensioner age or, for me, having kids (although some CF people do have children). But I'd just like to add the other side of the coin: that having a serious illness makes you genuinely understand the brevity of our life on earth and that means that some of us don't want to put up with shit relationships just so we can say we are attached. I'm pretty sure I once dated someone who was attracted to 'ill' people as it made him feel more like a man. I've also dated people who have emotional problems of their own that my crap lungs seemed like a small 'problem' in comparison. I didn't want to stay with either of them just because they were 'willing' to date me.

Anyhow, I think for teenagers growing up with an illness dating is a bad enough worry without walking round town and coming across posters hailing you and 'your sort' the new undateables.

What does everyone else think? Is this programme a good idea or an absolutely crap one?

p.s. I'd just like to add I'm married to the most amazing man in the whole world so for anyone reading this and thinking their health might prevent them meeting their love, then believe me IT DOESN'T!

The Government’s disability strategy out of touch with the reality of cuts

The Government is in the final week of its consultation asking disabled people to help develop its disability strategy. Maria Miller, minister for disabled people, has said that: “The Government is committed to enabling disabled people to fulfil their potential and have the opportunity to play a full role in their community”. But in reality it is clear that the Government lacks any cohesive policy that will enable this to happen.

In the last three years 31 people have died while awaiting appeals against Employment and Support Allowance (ESA) medicals that had found them fit to work. At their most vulnerable, the sick and disabled were left worrying to the day they died about how they and their family would cope financially while their illness was slowly killing them. Society should be in uproar that people in dire need turned to the state for help and were failed by it, but instead media and Government debate focuses on disabled ‘scroungers’, further isolating the disabled from their communities.

Yet while it could be argued in the case of ESA that Government incompetence is forcing disabled people into hardship, the same cannot be said for Personal Independence Payments (PIP), the new benefit that is replacing Disability Living Allowance (DLA). Under PIP eligibility rules, even if you cannot walk more than 50 metres and need a wheelchair to get about for any longer distances, a disabled person still won’t be eligible for higher rate mobility – which in short means they will most likely lose access to a car through the motability scheme and the freedom such a vehicle gives them that their body cannot.

By cold-hearted design, these ‘independence payments’ will in fact take independence away from severely disabled people and force them to remain in their homes. No wonder Lady Grey-Thompson, speaking to the Guardian last month, said: “I worry that it is going to become the way it was when I was young where you just didn’t see disabled people on the street because they were locked away.”

These aren’t the only cuts aimed at disabled people. The Department of Work and Pensions’ own analysis into the housing benefit reforms states that 450,000 disabled people will face cuts to their allowance under new rules. 78,000 disabled people who use legal aid to appeal against decisions to deny them benefit will lose this support under Ken Clarke’s reforms. The Independent Living Fund (ILF) has been entirely closed to new claimants and by 2015 payments to the 21,000 severely disabled people it helps will cease. Tax credits to help with the extra costs of raising a disabled child will be cut from a maximum of £54 a week to £27 a week under Ian Duncan Smith’s Universal Credit changes – cuts that the Children’s Society says will see some families with disabled offspring £1,400 worse off a year. According to a Government Select Committee on Health, nearly two thirds of local authorities in England have reduced their disabled and adult social care budgets. As such councils have drastically altered their criteria for providing care to disabled adults, leaving many people unable to wash and dress themselves properly isolated in their own filth as they are not disabled enough to qualify for care.

These cuts will severely curtail disabled people’s ability to “fulfil their potential”. PIP will actually remove independence from disabled people, the scrapping of ILF will see disabled people condemned to care homes, decisions to limit ESA to one year, leaving 7000 cancer patients without any financial support while they are still too unwell to work, will only help in moving disabled people into poverty, not into the workplace. Cuts to legal aid will take away their voice, housing benefit remove them from often supportive communities and homes that are specially adapted for their needs. Harsh reductions in social care budgets will see people stuck in hospital for longer periods of time as they cannot be discharged into communities because they lack provision for their basic care. Disabled people were already twice as likely to be living in poverty than others before these cuts were imposed: no wonder disabled people up and down the country are scared stiff of these ‘reforms’.

The Government’s consultation document, entitled ‘Fulfilling potential’, makes specific mention of “tackling discrimination” towards disabled people and “promoting positive attitudes”. Yet charities have directly linked a rise in disabled abuse with the increasing rhetoric from Government ministers that disabled people are scrounging off society. 

So bad has the Government’s attitude become that disability groups are now questioning whether they can continue to work with it on shaping further welfare reforms.

By the end of this parliament, if all these cuts are implemented, far from disabled people fulfilling their potential, the Coalition would instead have successfully reversed twenty years of advances made in helping the disabled play a valued and active part in society. Shame on all MPs if that is their intention. And if it isn’t, then the Government must wake up to the impact of these cuts, ban negative ministerial rhetoric linking the disabled with ‘scroungers’ and honour its supposed desire to develop policies that give back respect and support to some of the most vulnerable people in society.