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Tuesday, 4 October 2011

A letter in today's Telegraph

Health Bill concerns 

SIR – As public health doctors and specialists, we are concerned about the Health and Social Care Bill. The Bill will do irreparable harm to the NHS, to individual patients and to society as a whole.

Of course, it will do no such thing. The NHS is a public organisation and can be reorganised at will. No change is irreversible, and no "harm", if any, is irreversible. 

It ushers in a degree of marketisation and commercialisation that will fragment patient care; aggravate risks to individual patient safety; erode medical ethics and trust within the health system; widen health inequalities; waste much money on attempts to regulate and manage competition; and undermine the ability of the health system to respond effectively to communicable disease outbreaks and other public health emergencies.

All of which is total nonsense. If we wanted to strip out the self interest from the NHS we would stop paying doctors salaries. Unfortunately for the rest of us, it seems that doctors are unwilling to work without financial compensation, so we have to pay them. Likewise, in order to get health organisations to provide the services we need, we have to pay them too, but in order to source those services on the most competitive terms we have to have some .... competition. 

All of which does nothing to stop the NHS responding to outbreaks of communicable diseases and other public health emergencies. If anything the process becomes more efficient.  And in case anyone thinks that is an exaggeration on my part, the response communicable diseases and similar health scares is handled by the Health Protection Agency which reports directly to the Department of Health.

While we welcome the emphasis placed on establishing a closer working relationship between public health and local government, the proposed reforms will disrupt, fragment and weaken the country’s public health capabilities.

No evidence given for this position. The reason for closer working is to give a better overlap between health and social care. It is well understood that one of the biggest future costs and also one of the current areas where productivity has to be improved is in care of the elderly, and this means getting the elderly out of hospitals and caring for them at home. 

The Government claims that the reforms have the backing of the health professions. They do not. Neither do they have the public’s support. The Health and Social Care Bill will erode the NHS’s ethical and cooperative foundations and will not deliver efficiency, quality, fairness or choice. We ask the House of Lords to reject passage of the Health and Social Care Bill

[Usual list of scores of self interested medics]

What they are really saying is that "Public Health" has long been the medical wing of the Labour Party with more interest in equality of outcomes than in maintaining the health of the nation per se, and best of all, the NHS pays them handsomely. NHS reforms would of course change a lot of that, with the abolition of the SHA's in which these Public Health types thrive.

But then we would hardly expect turkeys to vote for Christmas.

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