Treasury intervention at Papworth prioritizes debt over saving lives‏

As a recent double-lung transplant patient I was shocked to read that Papworth hospital is under threat of closure from the Treasury.  As the UK’s largest cardiothoracic hospital, it is one of only seven hospitals in the UK that performs heart and/or lung transplants, and, with the exception of Harefield (where I had my surgery), has almost double the number of patients in after-care then its nearest rival.

Yet this hospital’s vital and successful role in the UK’s delivery of transplants, amongst other essential services, is now at risk. The Government is demanding yet another review about moving Papworth services in part or in entirety to Peterborough City hospital, to help bail out the latter from its crippling debts. This comes despite the fact Peterborough’s debts are entirely unconnected to Papworth, which is one of the NHS’s strongest financial performers.

Transplants are incredibly complex procedures that need highly experienced clinical teams and specialized equipment for the surgery, and before and after care. It isn’t an exaggeration to say that the excellence behind these established teams is keeping people alive for longer.

Katherine Graham, who received a heart and lung transplant at Papworth last September, said: “I have seen at first hand the amazing work and dedication of staff and have received first class care at all times.” This personal experience is reflected in the hospital’s Friends and Family test score of 85%, the highest in East Anglia.

Yet Graham believes that a move to Peterborough “would result in diluting our care and the expertise that has already been achieved at Papworth and would jeopardize our futures.”  She’s right to be concerned. In addition to being debt-laden, in its most recent Care Quality Commission (CQC)  inspection Peterborough hospital failed to meet two essential standards, including providing appropriate care for its patients.

Back in July 2010, when the Government published its white paper on its intended radical NHS reforms, the foreword, signed by Cameron, Clegg and then-health minister, Lansley, said:
“Patients will be at the heart of everything we do. So they will have more choice and control, helped by easy access to the information they need about the best GPs and hospitals. Patients will be in charge of making decisions about their care.”

Controversially patient choice was intended to create a market in healthcare in which hospitals with excellent standards of care would thrive as more patients chose to attend them, while those who gave poorer care would be left to close if they couldn’t attract more patients by improving their services, and therefore gaining increased funding.

There are huge problems with designing healthcare provisions on this model, not least the fact that the poorest or most ill patients have less capability to travel far for treatment, but the Treasury’s intervention over Papworth undermines the reforms’ positive focus on patient experience as it is perversely penalizing one hospital for being successful and rewarding the other for failure.

Yet it is evocative of the future direction the Government is taking with hospital restructuring. Still brooding after appeal court judges ruled it acted illegally in cutting A&E and maternity services at London’s Lewisham hospital, the Government is pushing a critical amendment to the Health care bill through parliament. It would allow administrators to force changes upon financially viable hospitals which neighbour failing hospitals, without the need to consult patients or doctors.

It is a fallacy to say that patients will have any real influence over NHS spending when services at their local or chosen hospitals can be closed without clinical justification, or, in many cases, when closure would actual harm outstanding care. The drive for improved health standards that patient choice was meant to champion cannot succeed if hospitals which provide excellent care are seconded to those that have the highest debts.

I am incredibly grateful to the NHS and the team at Harefield who helped give me back my life through a transplant. I would be devastated if my friends’ chances of getting the same life-changing opportunity at Papworth are jeopardised by this Government’s chaotic and unfair attitude to hospital reorganization which prioritizes reducing debt over saving lives.

Citizen journalists are the main target behind the Tories' archive deletion

This week the Daily Politics show discussed whether the 2015 election will be the year that internet campaigning comes into its own. Moreover, The Independent recently reported that Labour's 2015 campaign will put on emphasis on the internet, as all parties look to emulate Obama's success in 2008 which many credited to his utilisation of the internet.

If the internet really is the new election ground to be fought over, then the Conservative party's decision to delete all content prior to 2010 from both its website and the main internet library is even more authoritarian then first thought.

Rightly so, its been accused of deleting its pre-election promises so that the electorate are less able to hold it to account come 2015. The Guardian reported that the only way to access this information now is to visit the British Library and trawl through archived copies of the Tories' site. It may be possible for a national newspaper to find resource to do this but it is unlikely citizen journalists can manage such a colossal task.

If the internet is to be the medium that chooses the next Prime Minister suddenly it seems a master stroke by the Tories to reduce the information available to bloggers.

As an ex-PR man, Cameron is adept at manipulating the press. He's been accused of refusing live interviews with harder-hitting news sources in favour of pre-recorded pieces or 'easier' interviews on shows such as 'This Morning'. Ian Duncan Smith is a master at spin and has repeatedly misused statistics to promote his own ideology.

But its on twitter and Facebook that these tricks are called out by citizens who take the time to spread the real truth behind sensational, inaccurate or plainly wrong headlines. And it works because citizen journalists are diligent at linking to their sources.

Indeed one of my most read blogs was a piece denouncing the Telegraph's coverage of the scrapping of Disability Living Allowance. I think it was particularly well read because it used the Government's own sources and statistics to refute the misinformation spread by Duncan Smith.

But if I now want to highlight how Cameron consistently misled the public about his intentions towards the NHS or the disabled community I've got to rely on second-hand sources to do so. And I may trust the Guardian but I know not everyone who reads my blog does. That's even more true when it comes to political parties. Labour can highlight all the promises the Tories have broken but it will be harder to drive the message home as we've all become fatigued by the leading parties constantly taking a swing at each other.

In Cameron's own words it is clear why he is trying to limit the information available to citizen journalists and therefore the influence social media can spread. He told the Google Zeitgeist Europe conference in 2006: "You have begun the process of democratising the world's information. By making more information available to more people, you are giving them more power."

Social media is still an unknown entity - which political party will benefit most from it come 2015? That question has certainly got the Tories worried.

ESA cancer concession signals popularity contest for disability benefits

The news that the Government is softening its harsh approach to cancer patients claiming sickness benefits is a welcome relief. Yesterday it announced that the one year time limit for recipients of Employment and Support allowance will only start counting down once the patient has finished all their medical treatments. It has also said that cancer patients can avoid the WCA medical test carried out by Atos as a GP's report will be acceptable proof for the benefits office.

Finally, we think, the Government is being reasonable. It is trusting NHS doctors again to verify the health of their patients and at last recognises that forcing cancer patients to attend DWP job interviews will only slow down their recovery.

Yet perversely this common sense approach to benefits locks the Government into ever more irrational behaviour. As these changes will only apply to cancer patients, other people with just as serious illnesses will still be locked into an unfair system in which they will lose benefit payments after one year even if they are not well enough to return to work - remember the Government's own estimates show that 94% of people who received time limited ESA will not be better after 12 months. The work-focused ESA also forces sick people to seek jobs, attended job centre interviews and even do unlimited work experience while they are still too sick to work.

So yes this change is great news for cancer patients but it stinks to me of a Government running scared that the public is waking up to how punitative and harsh its sickness benefits system is, and is desperate to avoid appalling headlines like this one. Cancer receives widespread media coverage as it can happen to anyone at any time, so come the election such Government negligence could have become a real door-step issue. But ultimately if the Government recognises changes are needed for ESA and the WCA it has a duty to ensure that they are rolled out universally not just for a particular group of people for whom there is greater public sympathy or understanding.

Just as worryingly this shift in policy sets a precedent that those illnesses that have popular support from the public will get a fairer hearing in the huge welfare upheaval than those who suffer from rare or unpopular illnesses (think what a rougher ride those with depression receive from the tabloid press).

Earlier this year Ian Duncan Smith announced that under Personal Independence Payments (the controversial benefit replacing Disability Living Allowance) amputees will be unlikely to receive the top level of mobility support that they currently do under DLA, and warned the public that this would also apply to soldiers.Yet Cameron intervened saying that amputee war veterans will be exempt from the harsh restrictions planned for the mobility component of PIP.

How can Cameron argue that a civilian with a below the knee amputation caused by a road traffic accident is any less disabled than a soldier with the same amputation caused by an IED?

I can see the way the wind is blowing on this issue and I for one don't want a society in which people with illnesses are pitted against each other in some bizarre X-Factor-style media popularity contest as the rest of us judge who is and isn't deserving of fair treatment.

NHS could be the real problem for the coalition come election time

After last week’s wake-up call at the local elections, the Coalition is under pressure to re-examine how its policies reflect voters’ expectations. While there is much debate about the merits of Lord reform, gay marriage, austerity targets and growth policies, the two parties would do well to turn their attention to recent passing of the Health and Social Care bill.

Yesterday’s decision by the Government to veto the information commissioner’s legal demand to publish the risk register reminds us all what a controversial bill this truly was. The Government is still not keen to reveal to the public the extremities of the risk assessment, although an early version of the register, leaked in March, suggests that the worst case scenario of these reforms would be that “the Bill proceeds, without assurance that the whole system is affordable." The document continues: "There is a risk that costs of the future system cannot be controlled."

No wonder the bill received such widespread criticism in the run-up to it becoming law.  In February this year, eight significant health organisations fully opposed the bill, two opposed it in its current form and three were neutral. On top of that a YouGov survey showed the 65% of NHS staff wanted the bill withdrawn in its entirety.

I repeat these statistics as it shows the uphill battle the Government has to secure good outcomes from such a fiercely unpopular policy.

Since the bill became law there has been on-the-ground confusion on how best to implement its policy’s, a situation not helped by aggressive private companies there were waiting in the wings ready to take advantage of this initial knowledge vacumn. Virgin now controls 18 NHS contracts across 15 counties, and Labour back-bencher Dr Éoin Clarke estimates that £2 billion worth of NHS contracts have now been given to private companies.

Despite this plethora of contracts there is no evidence that such outsourcing of NHS contracts will deliver better services, increased choice or long-term control of costs. Indeed, the first NHS hospital to be completely privately run, Hinchingbrooke in Cambridgeshire, has recently caused a furore by announcing it intends to make a profit of £60 million in the next decade despite concerns that to do so would mean making 'eyewatering cuts'. On top of this there are ludicrous stories of physiotherapists who aren’t allowed to touch their patients following a new contract agreed by Principia clinical commissioning group (replacing the local Primacy Care Trust) in Rushcliffe, Nottinghamshire.

If a patient is unhappy with the care they are offered they can complain to Healthwatch, but they’d have to wait five months as, despite the fact that the bill is already on the statute books, it doesn’t launch until October this year. Once this organisation does finally get round to opening, it can then pass on complaints to the Care Quality Commission (CQC) which is now responsible for ensuring that private health providers are honouring the quality expected of them. This is the same CQC that has been overseeing private social care providers since 2009 and has twice been humiliated by BBC Panorama revelation's of abuse at care homes that the CQC had already inspected multiple times and declared acceptable. Despite clearly struggling in its current role, the Government expects the CQC to more than double its workload with 30% less staff.  The public may accept private providers profiting from NHS work, but in exchange it will expect the service it receives to be better than what is currently on offer and it is clear that the systems in place to manage this are already found wanting before they get off the starting block.

It isn’t even clear that in the current rush to implement these reforms the basic principles of free market capitalism are honoured, a principle that is the bedrock behind the spending decentralisation of this Tory-led Government. Despite health secretary Lansley’s much vaunted initiative of giving GPs the budget and power to buy services for its patients, it is alleged one local commissioning group in West Sussex weren’t told about a new contract award to Virgin healthcare until after it was signed off.  The commissioning board were therefore not able to consider the merit of the bid in comparison to other interested parties – a clear failure of the health bill’s objective of tendering-out NHS work to help achieve better value for money for the taxpayer.

After such a turbulent month the Government most probably couldn’t bear the horrendous headlines that would result if it revealed what risks it is truly taking with our beloved NHS. But whether made public or not, those risks outlined by the risk register still remain. No doubt the Government is hedging its bets that the new Health Bill would have bedded in by the time an election is called in 2015, and any initial concerns by the public would have been proved false. Three years is also enough time for the NHS as we know it to have unravelled, for charges for non-urgent surgery or treatment to be mooted, for waiting lists to grow, for private companies to make large profits while limiting the contact patients have with doctors. And the first few months of policy implementation don't embue one with confidence that the NHS is in safe hands.

So Cameron and Clegg be warned: the battle to push the health bill through parliament could prove miniscule compared to the battle on voters’ doorsteps in 2015 to convince them that you can be trusted with the NHS.

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.

Cameron’s attack on ‘sicknote culture’ could spectacularly backfire

Speaking today to the Daily Mail about sickness benefits, David Cameron couldn’t have been more right when he said the “whole system is in a mess”. But his new proposals are likely to make things worse.

Cameron is keen to “press ahead” with stripping GPs of the ability to sign people off work for more than four weeks. After this period an independent assessor will be needed to verify if that person needs to be off sick. Considering this is the same Government that wants to give control of the majority of the NHS budget to GPs, its faith in local doctors seems surprisingly contradictory.  With the Government still embroiled in arguments with clinicians over its planned NHS reforms, the Government could find there is little appetite for these new proposals with either GPs or the electorate - indeed an Ipsos Mori survey in June this year showed that nearly nine in ten respondents trust their doctors to tell the truth.

What is clear is that, if implemented, these changes will add another expensive layer of bureaucracy onto a benefits system this is already struggling to cope.

Atos Healthcare is the independent assessor contracted by the Government to carry out the Working Capability Assessment (WCA) that the vast majority of applicants for Employment Support Allowance (ESA) must undergo. Frankly, the assessment isn’t working. 40% of decisions that people are ‘fit to work’ are overturned at the appeal stage, and these original decisions are very heavily based on the findings of the WCA. It is not solely ‘borderline’ cases that are eliciting appeals. In June evidence was submitted to a parliamentary select committee that highlighted the case of Mr C who died in the five months between his medical assessment, in which he was declared fit to work, and his appeal hearing. In February this year Scotland’s Evening Times reported the deaths from chronic illnesses of two men who were waiting for appeals to be heard against their recent loss of Incapacity Benefits. I could go on.

The Government already pays Atos £801 million over a ten year period yet, despite many ministerial promises of improvement, it’s clear that the Government has a long way to go until it gets to grips with how to assess how someone’s illness affects their ability to work. Until it manages to get WCA appeal rates under control, there is little point adding another hefty bill to the taxpayer’s purse to extend the number of ill people required to undergo independent assessments.

Cameron says that GPs “resent being asked to sign sicknotes” yet I can’t imagine any GP embracing a system that might tell patients to go back to work against their own doctors’ advice. And what will happen to those patients who are told they are fit to work when they aren’t? Will their pay be stopped while they appeal the decision? Will they face being sacked for ‘lying’ to their employer?

I can only presume that in these tough economic times, in which many people are struggling with the steep rise in the cost of living, Cameron believes that cracking down on “sickness fraud” will be a vote winner amongst the electorate. Yet that argument only holds when the wider public holds an ‘us’ and ‘them’ view – when we believe that it would never be ‘us’ who are presumed to be lying about being ill.

The Government is only getting away with the terrible mess surrounding the WCA, and the staggering £80 million cost to the taxpayer to manage the hefty appeals process, because it isn’t yet seen as a mainstream concern.  As soon as anyone who is off ill for more than 28 days is told to undergo similar tests - and the word spreads about what a hit and miss process it truly is - Cameron could face a massive backlash against his benefits policies. Most people want to work hard and show loyalty to their employer: in exchange they expect to be able to take time off to recover from unexpected illnesses, even if that recovery process takes longer than hoped. I can see few people accepting this greater state intrusion into their lives.

Are Lansley's days well and truly numbered?

I would love to be a fly on the wall in the Government's health department at the moment as the department's policies have recently been attacked from all directions. Health charities, coalition MPs and nationwide GPs have very publicly criticised different aspects of the Government's health policies and I would think that Andrew Lansley, the Secretary of State for Health, will probably spend the upcoming weekend contemplating how much longer he can cling to his post.

To give you some background, Lansley was Shadow secretary for health for ten years before the Tories formed a Government last year. It seems that spending such a long time in a single role in opposition has left Lansley with incredibly ambitious ideas that seem one step removed from the practical reality of a country with a shaky economy. Indeed so protective has Lansley been of his department, rumours have been circulating that it has isolated itself from all other Government offices. A BBC World at One report earlier this year revealed that Cameron has increased the number of policy advisors at Number 10 so he could get a better understanding of the health policy that Lansley has been guarding behind closed doors.

Back in 2001, Britain was starting a decade of cheap credit, low cost of living and continuous growth. As the decade progressed, Lansley could be forgiven for thinking our country was stable enough to allow for the biggest reorganisation of the NHS since its inception in 1948. However, so keen is Lansley to unleash plans that were so long in the making, he seems unwilling to recognise that the country is very different to what he had envisioned. Lansley's NHS reorganisation is meant to cost anywhere between £1.4 and £3 billion pounds - and with the UK supporting a massive deficit it is no wonder the nation is wondering if we can afford these changes right now. Moreover the meltdown of the UK banks has left our country more political. Whereas in the good years we might have been too busy buying expensive clothes on credit and binge drinking away our weekends to criticise our politicians, in our current sober times more and more British people are vocally questioning Government policies.

Yet despite this climate, Lansley announced a "revolution" of our NHS when he released his department's NHS white paper last July. As doctors, health charities, journalists, patients and opposition MPs have begun to understand the implications of this white paper, the dissent has slowly risen. Even Cameron's direct media intervention earlier this year to help 'sell' the Government's NHS white paper has done little to assuage mounting criticism. Cameron may now be calling the NHS changes an "evolution" instead of a "revolution" but many still believe his NHS proposals are leading us down the road of privatisation.

And so to this week. The British Medical Association called an emergency meeting, the first for 17 years, in which GPs voted in favour of the motion that Lansley entirely withdraw the Health bill currently going through parliament and halt reorganisation plans. In separate news, on Monday six health groups refused to sign up to the Government's 'responsibility deal' on alcohol saying that the voluntary measures do not ask enough of the drinks industry. Don Shenker, Chief executive of Alcohol Concern, said that the Government's public health policy's "first priority is to side with big business and protect profits". Finally, Lib Dem activists have voted overwhelmingly to reject the Coalition's NHS reforms as they believe they are unjustified and will be highly damaging.

So where to now? My feeling is that David Cameron will fall back on his old PR background and consider that the way to win round voters is to alter the presentation of NHS reforms. And perhaps he will conclude that Andrew 'Revolution' Lansley is now too toxic a figure to be spearheading such divisive changes. Such a move would suit Clegg as well who, after the fallout of tuition fees, has to show his party that he has listened to their doubts. So I think Lansley's days are numbered and if rumours on Twitter are to be believed a possible replacement might be Grant Shapps, currently the minister for housing and local Government.

But Clegg and Cameron should be warned. A change of Minister might win them some breathing space but they will still have a case to answer as to where the electoral mandate is for such reforms. Neither the Tory or Lib Dem manifestos mentioned such sweeping changes to the NHS, and the Coalition document was also silent on the issue. Lansley may well be forced to fall on his sword but that sword is razor sharp and capable of taking many more victims.