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.

Reason #1 why the NHS bill should be dropped

Under the NHS bill currently being debated in the House of Lords, provisions have been made that allow all NHS hospitals to allocate 49% of their beds to private patients. Which means waiting lists will automatically double in length and us lot who are already over-stretched paying bills and can't afford private healthcare, will be at the back of the queue.

Makes a mockery of Lansley's recent demands that hospitals get their waiting lists under control!

I'll post reason a day that the NHS bill is a disaster while it is being debated in the House of Lords.

Three reasons to sign the 'Save the NHS' petition

I've been watching the progression through parliament of the Health and Social care bill with alarm. This is a major piece of legislation that MPs don't seem to have given proper time to and it has been waived through the Commons despite mounting protests from GPs, consultants and public demonstrations.

The Bill is now in the House of Lords and the vote is expected to take place tomorrow on whether it will approve the Bill. Below are three reasons you should sign the petition by 38 degrees.This is our last chance to halt the reforms and demand a proper consultation with open explanations of the Bill's intentions. The list below is not comprehensive so please do add more in the comments section.

1. We live in a democracy and the way this Bill has been handled is thoroughly undemocratic. I've posted on this Bill before, but in short the Bill looks to give GP commissioning powers and open up the NHS to'any willing provider' (although this has recently been amended to 'any qualified provider'). Yet these crucial changes are already being enacted across the country with Health Secretary Lansley saying that 97% of the country is now covered by GP commissioning and current Primary Care Trusts are tendering out health contracts to 'alternative providers' (i;e. private companies). This has all happened while the Bill was officially 'paused' by David Cameron. It is unacceptable that any elected Government enacts controversial reforms without the approval of an elected parliament. I would hate the Health Bill to set a dangerous precedent. There is also the glaring fact that these reforms do not have an electoral mandate as they did not figure in either Coalition parties election manifestos.

2. The Bill does not have the backing of the majority of the medical profession. They believe it poses a fundamental risk to patients' health and to the NHS. This should be a major warning sign to us all. After showing patience with the Government, engaging in two consultation processes and cooperating with the Government on suggested changes to the Bill, the community has now come out in desperation calling on the whole Bill to be suspended. If the doctors working in the NHS are against this Bill, then we must question the motivations of the Government to pursue such changes. Either they are arrogant and believe that MPs know the NHS better than people who have dedicated their lives to working in it OR these reforms are nothing to do with improving the NHS.

3. The future implications of the Bill are far from clear. Cameron has promised not to privatise the NHS but the more I think through the proposals this seems like clever word play. The White paper gives commissioning powers to GPs who are officially private employees with NHS contracts. The paper does not say whether giving them commissiong power means that they will automatically becoming employees of the state. The Bill is pushing for the NHS to operate on free market principles in which providers compete for patients, and the Government funding they bring with them. This might explain why the Bill states that all hospitals are to become 'social enterprises' (i.e free from state control) and that those hospitals that can't manage their finances properly will be allowed to fail.

Adding this up in my head, it seems that the Bill is moving us to a state insurance system in which the UK Government doles out cash to private providers yet ultimately will one day not own any hospitals or pay for any staff. This ultimate aim may well be why the Health Bill in its current form doesn't explicitly state that the Health secretary will have ultimate responsibility for the NHS - how could he if the 'NHS' just becomes a pot of money that is divided out between private companies? Would an insurance system be better for the UK? Who knows because there has been no open debate about it as the Government has been so quick to push the Bill through parliament and refused to be honest about where this legislation is leading us.

Please sign the petition. The Government claims that the NHS must reform if it is to remain able to care for an ever increasing and elderly population. That may well be true but this isn't the way to manage such reform. We elect our Government and in turn they should be honest about the problems the NHS faces and the potential ways to manage healthcare in the future. Pushing through undemocratic reforms, which lacks the support of the medical profession and the understanding of the public treats the NHS and the voting public with contempt.

Increased waiting times signal Government is losing control of NHS funding

A few stories in today's press got me thinking today. The first is about a man who is taking the NHS to court for refusing him a gastric bypass as, at 43, his BMI is not high enough to warrant the operation. The Daily Mail has responded to this in its typical manner with a headline screaming: 'Give me a gastric bypass! It's my human right'. Although many of the Mail's headlines are unfair this one is particularly harsh. The man in question has type 2 diabetes which has already caused him blindness in one eye, complications with his kidneys and he is now a wheelchair user. A gastric bypass has been shown to cure type 2 diabetes so this operation could literally save his life. He has already asked his Primary Care Trust (PCT) to deviate from their normal 'rules' over who is entitled to the operation on the grounds his other health issues make him an exceptional case. Yet his application was rejected. Moreover if he had lived in the neighbouring PCT he would have received the bypass without any appeals as they allow the operation for anyone with a BMI over 35.

Another article that caught my attention was a piece in the Guardian showing that NHS waiting times are increasing. The Guardian revealed that "The number of patients waiting more than six weeks for a diagnostic test has risen from 3,378 to 15,667 in the last year". Even more outrageous is "the small but growing number of cancer patients having to wait more than one or two months for treatment". This has left doctors to make the point that such delays could ultimately mean the difference between cancer killing their patients or not.

I'm not going to delve into the emotional stress faced by people waiting for diagnostic tests but instead will use the Coalition's favourite argument for reforms and talk in monetary terms.

It is clear to any rational person that delaying treatment for cancer patients or for those who are critically obese will cost the NHS more money in the long-term. Cancer that takes longer to cure costs the NHS more in bed space, consultancy time and medicine. A man who's obesity is causing diabetes to threaten his kidneys and his ability to walk will also increase costs to society, both medically and in social care.

I've spoken many times about the fact that the NHS is meant to be saving 4% every year for the next four years. Many economists believe this is impossible and as these heath rationing stories increase it seems that they are right. And what is this health rationing to achieve? Ill patients don't get better without treatment so clearly the costs won't go away unless patients are left to die or, as perhaps the Government hopes, seek private treatment.

To meet today's monetary targets, tomorrow's will be astronomical. This is seriously a case of false economics.And as we are only in year two of a five year cost saving plan it can only get worse. If something doesn't change waiting lists will soar.

The Government is so focused on pushing through its radical NHS reform plans, it seems to have lost the will to keep today's NHS functioning. Instead we are left with a postcode lottery of care and a Government insisting that waiting lists are 'broadly stable'. Tell that to the cancer patient who had to wait two months to start treatment.

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.

NHS should fight back against profiteering drug companies

Antibiotics are beginning to fail. For someone completely dependent on antibiotics every day (3 different types daily and a few administered directly into my veins every couple of months) this worries me.

There are already a few strains of CF bugs that are resistant to most antibiotics - they are the true bogeymen of the CF world, talked about in hushed tones - and the common chest infection that most CF people have, pseudomonas, shows on and off resistance to the usual antibiotics.

But even I, someone who is more interested in antibiotic resistance than the average member of the population, was shocked to read recently that there have only been two new classes of antibiotics invented in the LAST THIRTY YEARS.

We should all be worried - infections are a bit like freedom fighters, they've got nothing to lose, everything to win and are highly proficient at adapting and resisting any of the tactics we use to try and kill them. And to be frank we've barely varied our tactics since 1980.

David Brennan, Chief Exec of big drug company Astra Zeneca has called upon the public sector to work with it to help find a way to solve the problem of antibiotic resistance. This is because drug companies see little value to their shareholders in spending money creating new antibiotics because the speed at which infections become resistant to them does not make it a worthwhile investment, regardless of the human benefit.

A spokesman for Astra Zeneca was quoted as saying: ""If we think [a treatment is] not commercially viable, we can give it to somebody in the public sector who is willing to spend money to develop it."

But to me this statement seems very one-sided. Drug companies make vast profits from the NHS - just look at the controversy surrounding GlaxoSmithKline's 10 per cent profit increase on the back of the swine flu panic. Plus their patent protection on drugs allows them to keep the cost of purchase high for a substantial period of time before they are legally obliged to divulge drug ingredients to allow cheaper, non-brand versions of the drug to be created.

A commercial approach to medicine works if profit proves an effective driver to creating new treatments. But if a focus on profit also means that vital drug treatments do not receive investment then to me something is clearly wrong with the system.

It has bothered me for some time that the NHS doesn't seem to use its huge buying power to exert demands upon drug companies. It must be one of the biggest, if not the biggest unified drug purchaser in the world, and it seems crazy that pharmaceutical companies are selling drugs to our Government at a vast profit but then also telling the Government to spend its own money creating cures for diseases that are unattractive to pharmaceutical shareholders.

I wonder what Astra Zeneca's reaction would be if the NHS said it would only buy its leading antibiotics for the whole of the UK population if they invested a proportion of the resulting profit in creating new antibiotics? Negotiation and bartering are the key to any purchasing agreement and at the moment it seems the Government is held to ransom over the threat of allowing its citizens to develop untreatable infections, when it should actually be using its huge monetary resources to ensure it holds the advantage over drug companies.

If we are forced to take a commercial approach to drug treatments, then the Government should quickly learn that two can play that game.

Have you been consulted over the proposed changes to YOUR NHS?

I promised to write regular updates on the planned changes to the NHS so here we are.

Unison announced this week that it's planning legal action against the Government's plans to give a vast chunk of the NHS budget to GPs (abolishing PCTs) and effectively privatise hospitals by turning them into businesses that compete for money from GPs and can treat an unlimited number of private patients.

The coverage unions get from the media is undoubtedly overwhelmingly negative, as the age in which they were championed has been replaced by a society modelled on individual rather than community spirit. But it's this very shift in how our society thinks about itself that makes unions so vital as their strikes and legal actions, act as a worthy balance against Government plans that are often focused on profits over community.

Unison believes that the Government's consultation about its NHS white paper, which it is legally obliged to undertake, is unlawful. This is because Department of Health has already indicated that its plans are non-negotiable making its consultation irrelevant and unable to effect change. The Guardian reports that the day after the white paper was released in July: "Sir David Nicholson, the NHS chief executive, wrote to NHS executives telling them to start work on the reforms "immediately".

What I didn't realise is that the NHS has a constitution of which the State's own website says: "No Government will be able to change the Constitution, without the full involvement of staff, patients and the public,"

Having read through the constitution, it does seem unbelievable that such sweeping changes can just be unilaterally imposed, especially as the more radical suggestions were not even mentioned in either the Tory or the Lib Dem election manifestos.

As an example, one of it's patient rights it outlined is: "The right to expect your local NHS to assess the health requirements of the local community and to commission and put in place the services to meet those needs". It goes on to say that this is the "responsibility of your local PCT". However as the Government plans to abolish PCTs it is clear that this right will be altered, at least in terms of who will be responsible for implementing it.

Moreover as of April 1st 2010, there was a new patient right which outlined that each NHS patient must be able to see a consultant within 18 weeks from referral by his or her GP. This right has already been abolished when Health Secretary Andrew Lansley announced in July that waiting times were being axed as they were too bureaucratic.

So bravo to Unison for highlighting our right to question these NHS changes. If this radical white paper is the best way forward for our national NHS then why not explain the changes and the benefits and let doctors, nurses and the public have proper involvement in whether they should be implemented?

Has anyone yet been consulted over these changes? Have you seen a single poster, email, or TV appeal asking for your opinions? Fingers crossed this legal challenge slows down the implementation process so that we all have a chance to think about and campaign for an NHS that we all want, not just one that works the best for the Treasury coffers.

Local variances in diabetes treatment challenges the use of 'National' in NHS

A recent national diabetes audit examining differences in patient care across the UK has revealed that almost 60 per cent of those with diabetes are NOT receiving effective care - despite the fact that 90 per cent of diabetic patients are now meeting healthcare teams at least once a year. Of nine recommended care processes that each diabetic patient should be offered, routine urine tests to detect early stage kidney failure is still the least used test - over a third of patients were NOT offered one. Statistics might seem dry but the fact that there has been a 20 per cent increase since 2003 of diabetics needing kidney dialysis or transplant demonstrates how serious these patient care 'oversights' can be.

These variances in health care across the UK are simply unacceptable. If there is a routine list of tests that should be done on diabetic patients, then a GP should simply print it off and tick them off as he or shes goes along. It doesn't have to be any more complicated than that.

It's interesting to note that the data was compiled by statistics offered by Patient Care Trusts (PCT). For those of you who don't know, a PCT is a local body operating within or across a few boroughs that decide how its local 'money pot' should be spent. I've had enough dealings with my PCT to think of a more appropriate four letter word to represent the 'C' in the acronym. No doubt I'll mention the PCT again in my blog, but in my opinion they have more power then they should have and make random monetary decisions about treatment which is never based on what is best for a patient. And often their money saving initiatives are short sighted: it's more economical to keep a patients diabetes under control then deal with the costly consequences such as dialysis and complicated operations.

So, if you have diabetes or any long term illness then do your research. Get in touch with the charity that represents your illness, talk to other patients on health forums and go to your GP armed with facts. If it was me I'd print out the nine key tests that I need, ask for them to be done and insist on a referral to a hospital specialist team if my GP wasn't able to do them.

Until changes are made in the NHS to provide truly universal care, then knowledge really is power when it comes to managing your long-term health.