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.
Tuesday, 11 October 2011
Tuesday, 6 September 2011
NHS reforms pose worrying questions for Britain’s democratic process
At the end of April, amid growing condemnation of NHS reforms, the Government asked for a 'pause' in the Health and Social bill to allow it to perform a second consultation. As the third reading of the Health and Social bill starts today it would be fair to assume that a pause in the legislation has translated nto a pause in ground-level implementation. But that hasn’t been the case.
In early July, Lansley announced at the NHS Confederation conference in Manchester, that the 'pause' in the Bill was "over. It's now time to act” - which may explain the speed of reform over the summer.
After last year’s initial consultation process, when doctors said they would struggle to meet the 2013 deadline for all GP surgeries to be part of a local consortium to manage NHS budgets, Lansley declared in December 2010 he would “press ahead immediately with pathfinders of emerging GP consortia”. Ostensibly they would blaze a trail for the proposed reforms and help the Government discover any potential future pitfalls in the plan. However, since the Bill is yet to pass, these consortiums are operating “under existing legislation”. At best this seems undemocratic as, according to Lansley himself, 97% of the population is now covered by these consortia without any legislative change to account for this rapid transition.
This leaves the NHS reforms in a muddle as, in a speech at University College London Hospital in June, David Cameron scrapped the 2013 deadline for GPs to take on full commissioning responsibility. With PCTs already offloading staff (Freedom of information requests from 54 PCTs show that at least 2010 jobs have been shed through a combination of redundancies, unfilled posts and mutually agreed resignation) and some consortia further advanced then others, what will fill this authority vacuum?
A recent investigation by trade magazine Pulse found that only 84 PCT-led GP surgeries now exist in England and PCTs are re-tendering existing PCTMS contracts (for which they are directly responsible) under the belief that any such contracts still in existence by April 2013 will not be legal as PCTs will not exist. Of the four types of alternative contracts the PCTs could choose, 41 of these 84 practices have had, or are in the process of having, their contracts retendered under Alternative Provider Medical Services (APMS), which has been specifically designed to broaden the range of providers that GPs can commission from. In short it allows private companies to bid for GP contracts. Unison has said of APMS contracts: "Worryingly, APMS contracts allow for increased privatisation of primary care services and a profit-driven approach to health care provision".
Just as worryingly, some PCTs want to put out to tender entire care pathways, opening up its patient care provision to private companies. According to Pulse: "NHS East of England plans to auction off £300m of services to GPs, private companies or a combination of the two, in pathways including respiratory and musculoskeletal medicine." A further eight PCTs are expected to follow suit.
Yet the health bill’s most contentious aspect has been the desire to open up the NHS to “any willing provider”. Following strong criticism, the wording in the Bill is likely to be changed to “any qualified provider” meaning that all providers would have to meet a set of standards – yet as these are yet to be agreed upon, it seems the offloading of entire care pathways is moving faster than the legislation that allows it to.
Finally, the Department of Health has announced that Hinchingbrooke NHS hospital in Cambridgeshire has been given the go ahead to be run by a private company, called Circle Health, as long as the Treasury approves it’s “viability” . This contract has been given an initial green light despite the fact that the company in its recent flotation document warned that a profit might "become unachievable". Having watched the disastrous collapse of care homes operator Southern Cross, putting many patients at risk of becoming homeless, it seems extraordinary that the Government is considering allowing a company to take over a hospital when it has openly announced it may struggle to make and maintain a profit. This will call into question the long-term survival of Hinchingbrooke or the need for a Government bail-out should Circle Health fail to keep its investors happy.
When they return to debate the Health and Social Bill this week, I think many MPs will be shocked at the pace and extent of ground-level reforms. It seems almost inevitable now that GPs will take on some form of commissioning as PCTs have all but dismantled themselves, even though the Bill allowing this to happen has yet to be signed off. Meanwhile private companies are already sniffing out profits by taking on GP contracts, care pathways and even whole NHS hospitals. It poses worrying questions for Britain’s democratic process when the sitting Government pushes ahead with reforms while intense debate in the Commons has by no means reached its conclusion.
In early July, Lansley announced at the NHS Confederation conference in Manchester, that the 'pause' in the Bill was "over. It's now time to act” - which may explain the speed of reform over the summer.
After last year’s initial consultation process, when doctors said they would struggle to meet the 2013 deadline for all GP surgeries to be part of a local consortium to manage NHS budgets, Lansley declared in December 2010 he would “press ahead immediately with pathfinders of emerging GP consortia”. Ostensibly they would blaze a trail for the proposed reforms and help the Government discover any potential future pitfalls in the plan. However, since the Bill is yet to pass, these consortiums are operating “under existing legislation”. At best this seems undemocratic as, according to Lansley himself, 97% of the population is now covered by these consortia without any legislative change to account for this rapid transition.
This leaves the NHS reforms in a muddle as, in a speech at University College London Hospital in June, David Cameron scrapped the 2013 deadline for GPs to take on full commissioning responsibility. With PCTs already offloading staff (Freedom of information requests from 54 PCTs show that at least 2010 jobs have been shed through a combination of redundancies, unfilled posts and mutually agreed resignation) and some consortia further advanced then others, what will fill this authority vacuum?
A recent investigation by trade magazine Pulse found that only 84 PCT-led GP surgeries now exist in England and PCTs are re-tendering existing PCTMS contracts (for which they are directly responsible) under the belief that any such contracts still in existence by April 2013 will not be legal as PCTs will not exist. Of the four types of alternative contracts the PCTs could choose, 41 of these 84 practices have had, or are in the process of having, their contracts retendered under Alternative Provider Medical Services (APMS), which has been specifically designed to broaden the range of providers that GPs can commission from. In short it allows private companies to bid for GP contracts. Unison has said of APMS contracts: "Worryingly, APMS contracts allow for increased privatisation of primary care services and a profit-driven approach to health care provision".
Just as worryingly, some PCTs want to put out to tender entire care pathways, opening up its patient care provision to private companies. According to Pulse: "NHS East of England plans to auction off £300m of services to GPs, private companies or a combination of the two, in pathways including respiratory and musculoskeletal medicine." A further eight PCTs are expected to follow suit.
Yet the health bill’s most contentious aspect has been the desire to open up the NHS to “any willing provider”. Following strong criticism, the wording in the Bill is likely to be changed to “any qualified provider” meaning that all providers would have to meet a set of standards – yet as these are yet to be agreed upon, it seems the offloading of entire care pathways is moving faster than the legislation that allows it to.
Finally, the Department of Health has announced that Hinchingbrooke NHS hospital in Cambridgeshire has been given the go ahead to be run by a private company, called Circle Health, as long as the Treasury approves it’s “viability” . This contract has been given an initial green light despite the fact that the company in its recent flotation document warned that a profit might "become unachievable". Having watched the disastrous collapse of care homes operator Southern Cross, putting many patients at risk of becoming homeless, it seems extraordinary that the Government is considering allowing a company to take over a hospital when it has openly announced it may struggle to make and maintain a profit. This will call into question the long-term survival of Hinchingbrooke or the need for a Government bail-out should Circle Health fail to keep its investors happy.
When they return to debate the Health and Social Bill this week, I think many MPs will be shocked at the pace and extent of ground-level reforms. It seems almost inevitable now that GPs will take on some form of commissioning as PCTs have all but dismantled themselves, even though the Bill allowing this to happen has yet to be signed off. Meanwhile private companies are already sniffing out profits by taking on GP contracts, care pathways and even whole NHS hospitals. It poses worrying questions for Britain’s democratic process when the sitting Government pushes ahead with reforms while intense debate in the Commons has by no means reached its conclusion.
Monday, 11 July 2011
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.
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.
Wednesday, 1 June 2011
The Winterbourne abuse scandal provides a stark warning against NHS privatisation
This week's Panorama about systematic abuse of patients at Winterbourne View private care home was shocking and uncomfortable television. Yet behind the fear of the patients, routinely and daily abused by their carers, was a story to be told about how private companies operate in social care. And it is a story we must pay urgent attention to as our Government looks to open up mainstream NHS treatment to 'any willing provider' - exactly what has already happened in social care.
What truly shocked me about the Panorama programme, wasn't just the terrible individuals metting out suffering to vulnerable young adults, but the complete failure of the Care Quality Commission to identify the abuse. CQC is the Government regulator of social care providers, it is meant to ensure that private health providers that win Government contracts ensure that quality of service does not come a lowly second to a profit motive. Yet during three inspections of the unit the CQC did not uncover any inappropriate behaviour and, even more worryingly, it failed to act on three emails it received from a highly qualified nurse who used to work at Winterbourne which detailed the abuse at the unit. The question is: how many other units have passed a CQC inspection are also hiding dark secrets?
Whereas social care has already been opened up to private providers, the health service is still largely nationalised. Yet the Government's controversial Health and Social care bill wishes to allows 'any willing provider' such as private companies and charities to compete for health contracts. The Government will be reliant on the CQC and 'people power' to ensure these providers are of good quality.
Lansley in speaking with the Guardian in February believes that people will 'vote with their feet' and go elsewhere if the health service they receive is not good enough. I've doubted this is possible since I heard this claim - a person's ability to maintain family life and jobs relies very often on accessing local health care regardless of its quality. But the scandal of Winterbourne shows that very vulnerable people cannot exercise a choice at all. Which would leave them at the mercy of the CQC to ensure "quality and safety" from their health provider - if the CQC is already struggling to identify problem providers can it really be trusted to do so in the future with a vastly expanded portfolio of providers to oversee?
Moreover, while the Panorama programme caught the nation's attention over extreme abuse, it would be terrible if we saw a patient's basic safety as the only target to aim for. The documentary also showed that the patients, in the words of an expert, 'had nothing to do' day in and day out. Disgracefully the Government pays £3,500 a week for each patient to live there but other than basic carer supervision there appears no programme of activities or experiences that might enable a person to learn how to gain independence and move out of the institution. Where is the quality or value for money there? Winterbourne is meant to be a therapeutic environment yet one can only imagine that once Castlebeck, the company behind Winterbourne, creamed off its profits there was only enough money left for basic care.
The same day the Winterbourne scandal hit the nation's papers the alarm was also sounded on the financial fragility of Southern Cross, a provider of care homes for 31,000 elderly residents. City analysts believe that a series of poor decisions taken when it was owned by a private equity company have brought the care home to its knees, generating real fear amongst residents as to what will happen to them if the business folds.
There is no suggestion that care at Southern Cross is in anyway substandard but its financial concerns yet again leave highly vulnerable people exposed by the machinations of a private company in the pursuit of profit over consistent and reliable care.
I only hope that the public recognises that these simultaneous failures in social care are stark warnings of what could happen to our health care system if private companies are allowed to cherry pick services it wishes to offer, gleaning off profit at the very expense of the people it is meant to be providing a first-rate service to. At the very least, the CQC must not be given any more 'providers' to oversee until it has become apparent how widespread its failure runs, people are held to account, and meaningful reforms are implemented.
What truly shocked me about the Panorama programme, wasn't just the terrible individuals metting out suffering to vulnerable young adults, but the complete failure of the Care Quality Commission to identify the abuse. CQC is the Government regulator of social care providers, it is meant to ensure that private health providers that win Government contracts ensure that quality of service does not come a lowly second to a profit motive. Yet during three inspections of the unit the CQC did not uncover any inappropriate behaviour and, even more worryingly, it failed to act on three emails it received from a highly qualified nurse who used to work at Winterbourne which detailed the abuse at the unit. The question is: how many other units have passed a CQC inspection are also hiding dark secrets?
Whereas social care has already been opened up to private providers, the health service is still largely nationalised. Yet the Government's controversial Health and Social care bill wishes to allows 'any willing provider' such as private companies and charities to compete for health contracts. The Government will be reliant on the CQC and 'people power' to ensure these providers are of good quality.
Lansley in speaking with the Guardian in February believes that people will 'vote with their feet' and go elsewhere if the health service they receive is not good enough. I've doubted this is possible since I heard this claim - a person's ability to maintain family life and jobs relies very often on accessing local health care regardless of its quality. But the scandal of Winterbourne shows that very vulnerable people cannot exercise a choice at all. Which would leave them at the mercy of the CQC to ensure "quality and safety" from their health provider - if the CQC is already struggling to identify problem providers can it really be trusted to do so in the future with a vastly expanded portfolio of providers to oversee?
Moreover, while the Panorama programme caught the nation's attention over extreme abuse, it would be terrible if we saw a patient's basic safety as the only target to aim for. The documentary also showed that the patients, in the words of an expert, 'had nothing to do' day in and day out. Disgracefully the Government pays £3,500 a week for each patient to live there but other than basic carer supervision there appears no programme of activities or experiences that might enable a person to learn how to gain independence and move out of the institution. Where is the quality or value for money there? Winterbourne is meant to be a therapeutic environment yet one can only imagine that once Castlebeck, the company behind Winterbourne, creamed off its profits there was only enough money left for basic care.
The same day the Winterbourne scandal hit the nation's papers the alarm was also sounded on the financial fragility of Southern Cross, a provider of care homes for 31,000 elderly residents. City analysts believe that a series of poor decisions taken when it was owned by a private equity company have brought the care home to its knees, generating real fear amongst residents as to what will happen to them if the business folds.
There is no suggestion that care at Southern Cross is in anyway substandard but its financial concerns yet again leave highly vulnerable people exposed by the machinations of a private company in the pursuit of profit over consistent and reliable care.
I only hope that the public recognises that these simultaneous failures in social care are stark warnings of what could happen to our health care system if private companies are allowed to cherry pick services it wishes to offer, gleaning off profit at the very expense of the people it is meant to be providing a first-rate service to. At the very least, the CQC must not be given any more 'providers' to oversee until it has become apparent how widespread its failure runs, people are held to account, and meaningful reforms are implemented.
Thursday, 12 May 2011
Are disability cuts just aimed at 'scroungers'?
I'm in hospital for the next couple of weeks trying to get healthy for my upcoming wedding (one month to go!). I've just taken part in a Guardian panel piece about yesterday's Hardest Hit March which demonstrated against the Government's plethora of cuts against disabled people.
I know there seems to be a prevailing concept in the wider society that these cuts are justified because it is only effecting those that aren't truly ill and just want an easy life. But that really isn't the case. I wasn't well enough to go on the march yesterday so to do my bit I've compiled some news stories about how disabled people are already being effected by cuts and their fears for the future. Please just spend thirty minutes reading around the issue with an open mind.
The Guardian is obviously a good place to start but there have been stories cropping up in even the more right wing media. Here's a selection of writing to get everyone thinking:
Guardian: Disabled people are marching for their lives
Guardian: It is now officially unsustainable to support disabled people
The Sun: No Cash as leg may grow back
The Mirror: Amputee loses benefit after walking
Scotland's Evening Times: Call for fairer benefits test as men [declared fit to work] die
Guardian: 'The Medical was an absolute joke' Heavily researched piece on flawed ESA medical tests
The Independent: Disability charities raise welfare concerns
I know there seems to be a prevailing concept in the wider society that these cuts are justified because it is only effecting those that aren't truly ill and just want an easy life. But that really isn't the case. I wasn't well enough to go on the march yesterday so to do my bit I've compiled some news stories about how disabled people are already being effected by cuts and their fears for the future. Please just spend thirty minutes reading around the issue with an open mind.
The Guardian is obviously a good place to start but there have been stories cropping up in even the more right wing media. Here's a selection of writing to get everyone thinking:
Guardian: Disabled people are marching for their lives
Guardian: It is now officially unsustainable to support disabled people
The Sun: No Cash as leg may grow back
The Mirror: Amputee loses benefit after walking
Scotland's Evening Times: Call for fairer benefits test as men [declared fit to work] die
Guardian: 'The Medical was an absolute joke' Heavily researched piece on flawed ESA medical tests
The Independent: Disability charities raise welfare concerns
Tuesday, 3 May 2011
Are 85 hospitals under threat of closure?
A good day to hide bad news seems to be becoming a modern day adage in UK politics, and the Royal Wedding last Friday proved no exception. While the nation was giddy with nuptial fever, Monitor, the regulator of NHS Foundation trusts warned that hospitals may have to make 'efficiency savings' of 6 - 7% for each of the next five years. This is even worse than the original target set by the Department of Health of 4% for each year.
Worryingly these 'savings' were highlighted in a letter to Foundation Trust (FT) applicants - i.e. hospitals that wish to become a Foundation Trust but haven't yet. The Government has set a deadline of April 2014 for the remaining 85 hospitals and mental health units to achieve FT status. As such to become an FT they MUST achieve the financial savings demanded by Monitor. Aside from the fact that 'enforced savings' are really just a euphemism for cuts, the real question is what happens if these hospitals cannot achieve such savage savings?
The Government has avoided providing a Plan B for such hospitals, and it is unclear whether a hospital will be allowed FT status even if it is unable demonstrate it can balance its books under such stringent demands. An alternative would be to allow an extension to the April 2014 deadline (a possibility considering the climbdown on the GP commissioning deadline). But a third option is also very possible: hospitals will just be allowed to close down.
The 'Liberating the NHS: Legislative framework and next steps' document recognises that some "organisations" will not manage to "thrive" under the "tough financial times ahead". As a clear warning to those that struggle to balance their books, it states on page 134:
"Taxpayers' funding needs to be used to pay for the services that patients need, not to prop up failing organisations that make ineffective use of the resources they receive. The transitional arrangements will ensure that there is no unnecessary failure: if there are simple steps that can be taken to make an organisation succeed Monitor will retain a role during the transition to ensure that these steps are taken." (My own italics)
Furthermore, Dr David Bennett, head of the economic regulator Monitor, admitted to the BBC in March, that hospitals that get into financial difficulty will "ultimately close". So clearly the Government can envisage a scenario where a hospital will be allowed to fail and the implicit assumption is that the Government will place the blame squarely on that hospital for doing so.
Yet this is incredibly unfair on those hospitals that are yet to achieve FT status. They are now attempting to do so under a harsher remit than any of those who have achieved it to date: indeed these savings are so tough that leading health economists doubt they are achievable.
A 4% saving has already been criticised as unrealistic by health economists. But speaking to the BBC about these latest statistics, John Appleby, chief economist at the health think tank the King's Fund said: "I can see a hospital doing this [6% savings] for one or two years, but not five years".
So either the financial bar has been set so high as to be intentionally unachievable (allowing the Government to prune its expensive stock of hospitals) or the Government has no real understanding of what a 6% saving actually means to a hospital. Either way by 2014 patients will be understandably angry if their local hospital is under threat of closure, when in reality it was the savings targets themselves that were financially unviable, not the hospital struggling to meet them.
Worryingly these 'savings' were highlighted in a letter to Foundation Trust (FT) applicants - i.e. hospitals that wish to become a Foundation Trust but haven't yet. The Government has set a deadline of April 2014 for the remaining 85 hospitals and mental health units to achieve FT status. As such to become an FT they MUST achieve the financial savings demanded by Monitor. Aside from the fact that 'enforced savings' are really just a euphemism for cuts, the real question is what happens if these hospitals cannot achieve such savage savings?
The Government has avoided providing a Plan B for such hospitals, and it is unclear whether a hospital will be allowed FT status even if it is unable demonstrate it can balance its books under such stringent demands. An alternative would be to allow an extension to the April 2014 deadline (a possibility considering the climbdown on the GP commissioning deadline). But a third option is also very possible: hospitals will just be allowed to close down.
The 'Liberating the NHS: Legislative framework and next steps' document recognises that some "organisations" will not manage to "thrive" under the "tough financial times ahead". As a clear warning to those that struggle to balance their books, it states on page 134:
"Taxpayers' funding needs to be used to pay for the services that patients need, not to prop up failing organisations that make ineffective use of the resources they receive. The transitional arrangements will ensure that there is no unnecessary failure: if there are simple steps that can be taken to make an organisation succeed Monitor will retain a role during the transition to ensure that these steps are taken." (My own italics)
Furthermore, Dr David Bennett, head of the economic regulator Monitor, admitted to the BBC in March, that hospitals that get into financial difficulty will "ultimately close". So clearly the Government can envisage a scenario where a hospital will be allowed to fail and the implicit assumption is that the Government will place the blame squarely on that hospital for doing so.
Yet this is incredibly unfair on those hospitals that are yet to achieve FT status. They are now attempting to do so under a harsher remit than any of those who have achieved it to date: indeed these savings are so tough that leading health economists doubt they are achievable.
A 4% saving has already been criticised as unrealistic by health economists. But speaking to the BBC about these latest statistics, John Appleby, chief economist at the health think tank the King's Fund said: "I can see a hospital doing this [6% savings] for one or two years, but not five years".
So either the financial bar has been set so high as to be intentionally unachievable (allowing the Government to prune its expensive stock of hospitals) or the Government has no real understanding of what a 6% saving actually means to a hospital. Either way by 2014 patients will be understandably angry if their local hospital is under threat of closure, when in reality it was the savings targets themselves that were financially unviable, not the hospital struggling to meet them.
Tuesday, 12 April 2011
Widespread genetic screening risks creating 'inferior' citizens
Back in 1995, my 14-year-old self was sitting on the dusty floor of my all-girls’ school hall listening to a morning assembly. With the aim of promoting public speaking, each class had to give one annual school assembly speech on a topic of their choosing. That morning it was the turn of five 11-year-olds who had decided to tackle a topic beyond their years: abortion. At 8.50am on one nondescript Spring morning my whole life was pronounced worthless as they declared that mothers carrying foetuses with Cystic Fibrosis (CF) would understandably want a termination. As a CF sufferer myself, I laughed aloud at the suggestion. Even as the illness has slowly ruined my lungs over the years, my life is still definitely one that is worth living.
Yet a report out this week by the Human Genetics Commission reminded me of those thoughtless 11-year-olds. Its pronouncement that they see “no specific social, ethical or legal principles" against offering nationwide preconception screening of genetic conditions seemed, at best, ill thought through.
In its report, ‘Increasing options, informing choice’, the Commission recommends that any person should be eligible for tests to show whether they are a carrier of genetic abnormalities that could result in their child being born with illnesses such as CF or Sickle Cell Anemia. Currently such tests are limited to people who already know there is a family risk of such illnesses.
The report believes that by widening out pre-screening to every potential parent in the UK people “can make informed choices about the reproductive options available to them.” Yet these choices seem to be very limited: remain childless, have an abortion, or endure lengthy, and possibly futile, IVF treatment.
It is possible to carry out an antenatal test called Chorionic villus sampling to see whether a foetus has CF, so that the family can choose to abort the pregnancy before birth. Cystic Fibrosis is a tough illness and it cuts life expectancy by at least 50%. Yet people with CF can live a relatively normal life for long periods of time. We have active childhoods, careers of our choosing and a life lived independently. I have a great life full of amazing friends. I’ve had a brilliant education, a good career, and even now when my health is really quite bad I live with an amazing man who I’m marrying in two months’ time. Is this a life that would have been better aborted?
Moreover, it is easy to imagine a scenario where a childless couple in their fifties may look back on multiple abortions, undergone due to fear of bringing up a child with CF, and wonder if it wouldn’t have been better to have experienced parenthood with all the hardships and happiness it would have brought with it. Perhaps the knowledge that pre-screening brings may be as painful as the very grief it was aimed at avoiding.
If both parents are a carrier of the defective CF gene, IVF is the only way to be sure of not conceiving a child with CF. In a process called Pre-implantation Genetic Diagnosis (PGD) each embryo is screened to ensure it is genetically ‘normal’ before implantation in the womb: there is at best a 30% success rate. But with NHS funding currently under strain, IVF is being severely limited across the country. In the last three years, nearly one in five Primary Care Trusts (PCTs) have cut IVF funding, with nine areas refusing funding altogether. Even fewer PCTs are prepared to pay for PGD in comparison with traditional IVF procedures and privately the procedure costs £3,000 per attempt.
It would be a nightmare scenario if CF became a ‘poor’ person’s illness, only prevalent in parts of society that cannot afford private PGD sessions. What implications will this have into research for a cure, or for NHS and welfare provisions for people with such illnesses?
It is unsurprising that Dr David King, director of Human Genetics Alert, said that if the report recommendations were put into action "it will inevitably lead to young people [diagnosed as carriers] being stigmatised and becoming unmarriageable, and disabled people will feel even more threatened."
For me the recommendations of the Human Genetics Commission imply that a life with CF, or Sickle Cell, or any other serious genetic illness, is a life not worth living. Ultimately no one chooses to have CF but isn’t that different to taking active steps to avoid having a child with CF? The Commission seems ignorant of the fact that people with severe illnesses have a lot to give, both to the people who love them and the society of which they are a part.
Everyone has hardships in their life, and CF is mine, but living with it has given me strength as well as pain. Rather than encouraging people to consider children with genetic illnesses as inferior, it should be recognised that our society is in fact strengthened when it comprises a diverse range of people with their own unique way of living their life as best they can.
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