Lord Owen: Government acting with “no authority” over NHS reforms

Jos Bell reports on the latest criticism of health secretary Lansley's "fatally flawed" healthcare bill, from Lord Owen of.

Jos Bell is a co-ordinator for Lewisham S.O.S. NHS

“No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means” – Aneurin Bevan, In Place of Fear, 1952


The Health and Social Care Bill presents the coalition government with its biggest policy headache to date. Attacked by the British Medical Association and rattled by Liberal Democrat concerns, the coalition have been forced into delaying the bill and launching a “listening” process. They are left in a position described by Ed Miliband today as “utter confusion” on a bill he called a betrayal.

Lord Owen also joined the attacks today, confirming that he has written to the cabinet secretary to complain about the reforms. This follows on from his paper; ‘Yes to the NHS internal market – No to the External Market’, in which Owen criticised almost every aspect of Lansley’s bill. He has even called for the health secretary to be replaced.

Lord Owen is appalled at the destruction of PCTs, challenges Cameron and the coalition on betraying their election promises to preserve the NHS andstates that the bill will mean that the task of achieving integrated care will be even more difficult.

Speaking on Boulton and Co. today, Lord Owen said he was “a great advocate of the internal market” but:

“I believe that to go to an external market will do great damage…. It is basically treating health as another commodity… They (the coalition government) don’t even know if their new form of wording, “any qualified provider”, will invoke EU competition law.”

For a Tory party long concerned with any supposed EU interference this must create difficulties. Lord Owen also went on to question the legitimacy of aspects of the bill.

“They haven’t any legislative authority for this… They have no authority.

“You shouldn’t legislate in this chaotic fashion… I think there are far deeper issues in this legislation than we have realised… a lot of the democratic controls are going out the window.”

In his paper Dr Owen is unequivocal on the failings of the bill. He states that “for all its length the bill offers few insights into the purpose of the future NHS”.
Owen’s paper clearly differentiates between the manageable internal market and the predatory external market.

“The formation of an NHS European Office to deal, in part, with European Competition Law issues affecting NHS organisation should have been a warning sign.”

Lord Owen, a former health minister himself, goes to the nub of the conflict of interest, demonstrating that patient need will no longer be at the core of consultation, stating:

“The NHS in England as we know it will, under this bill, no longer maintain or even expect to provide a uniform national service.”

So much for the continuity of integrated pathways of care. Previous governments having always kept NHS tariffs at the core of purchasing policy. As Lord Owen points out:

“Providers would be able to undercut applicable NHS tariff prices – thus bringing competition into the core of our health system.”

As for the role of Monitor, Dr Owen decries the “abdication of the secretary of state’s responsibility for monies”.
Nor is Lord Owen alone in the line up of grandees who oppose the bill – we already know that Baroness Williams has delivered a barnstorming critique, also cross-bencher Baroness Mary Warnock and the surprise addition of Tory old boy Lord Norman Tebbit.

Tebbit has sharply criticised his own party’s front bench for arrogance and contempt, speaking up forcibly in support of the NHS, he alerts his party to the risks of patient cherry-picking, along with the sheer incapacity of the private sector to deal with complex cases. He summarises by saying that the only member of his family to receive private care is the dog.

In the final part of Lord Owen’s paper, he affirms that the bill will at the least have to be clearly amended across a range of areas – most particularly in matters of competition, conflict and medical ethics. He states “there must be no equivocation in this matter”. He also demands a slowing of the pace of the reforms, a second opinion from a Lords Bill Committee – and ends with:

‘The prime minister will hopefully act long before this happens in the summer and replace the existing health minister in the House of Commons and allow for fresh thinking and much less dogmatism.”

We can only hope that the emergency has been averted, enabling the Lords to take a six month review of the bill – the cross-benchers having clearly said that this is the only condition upon which they will admit it for a second reading. Meanwhile, for all of us involved in lobbying for the NHS, there must be no let up. Much of the bill has already been set in motion at arrogant variance with parliamentary protocol, and ongoing specialist advice.

The NHS needs our help if it is to survive in a form which will continue to support the health of all of our generations – present and future.

38 Responses to “Lord Owen: Government acting with “no authority” over NHS reforms”

  1. Sue Hoyle

    RT @leftfootfwd: Lord Owen: Government acting with "no authority" over NHS reforms: http://bit.ly/gy2ndz reports @LewSOSNHS's @Jos21

  2. Matthew Rhodes

    leftfootfwd Left Foot Forward
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  3. Jos Bell

    RT @leftfootfwd: Lord Owen: Government acting with "no authority" over NHS reforms: http://bit.ly/gy2ndz reports @LewSOSNHS's @Jos21

  4. Brit Lefit

    RT @leftfootfwd: Lord Owen: Government acting with "no authority" over NHS reforms: http://bit.ly/gy2ndz reports @LewSOSNHS's @Jos21

  5. Andy S

    RT @leftfootfwd: Lord Owen: Government acting with "no authority" over NHS reforms: http://bit.ly/gy2ndz reports @LewSOSNHS's @Jos21

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  7. Shamik Das

    #SaveOurNHS RT @leftfootfwd: Lord Owen: Government acting with "no authority" over NHS reforms: http://bit.ly/gy2ndz reports @Jos21

  8. Colin Reynolds

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  9. Lily Carter

    RT @shamikdas: #SaveOurNHS RT @leftfootfwd: Lord Owen: Government acting with "no authority" over NHS reforms: http://bit.ly/gy2ndz repo …

  10. paulstpancras

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  11. UKFreeNews

    RT @paulstpancras: RT @leftfootfwd Lord Owen: Government acting with "no authority" over NHS reforms: http://bit.ly/gy2ndz reports @LewS …

  12. James Doran

    Lord Owen: Government acting with “no authority” over NHS reforms http://bit.ly/hr2O8s

  13. Rosie

    RT @oranjd: Lord Owen: Government acting with “no authority” over NHS reforms http://bit.ly/hr2O8s

  14. Liberal Ideals

    Lord Owen: Government acting with “no authority” over NHS reforms: The Health and Social Care Bill presents the … http://bit.ly/eBILZb

  15. Remove Lansley to save NHS disaster – The Guardian

    […] (re)hired: Hundreds of sacked NHS managers may be taken back as Cameron …Daily MailLeft Foot Forward -East London and West Essex Guardian Series -Financial Timesall 499 news […]

  16. 13eastie

    The opposition to private providers offering NHS care is simply irrational.

    Patients nation-wide benefit from the competitive private sector already.

    How many of them enter a consultation saying they only want to be treated with state-produced drugs or instruments?

    How many stroke victims refuse an urgent CT-scan on the grounds that the technology was developed privately? (At vast expense by EMI, on the back of Beatles’ record-sales, and subsequently exported globally for huge taxable profits).

    There are countless similar examples.

    The private sector is the driver for innovation and progress in healthcare and it always has been.

    It is the involvement of the State in healthcare that brings about directly its greatest failings – failings which let down most the poorest and most vulnerable.

    1) TOP-DOWN-TARGETS: Labour failed time and time again to anticipate unintended consequences. This led directly to management obsession with and prioritisation of statistical targets that have no basis whatsoever in clinical fact. How long would a freely-competitive provider get away with providing the kind of care witnessed at North Staffs?

    2) PHONEY “CHOICE”
    Reliance on badly-produced league tables, based on hopelessly dodgy data, offers patients no sensible choice at all. E.g. Is the surgeon whose impressive statistics are based on turning away complex cases (due to management pressure to optimise mortality stats) the best person to see in clinic if surgery is your ONLY option? Patients don’t want choice. ASK PATIENTS WHETHER THEY WOULD LIKE THEIR GP TO BE ABLE TO ADVOCATE FOR THEM AND TO BANG HEADS TOGETHER LOCALLY AND THEY WILL ALWAYS SAY “YES”.

    3) VALUE-FOR MONEY TRUMPED BY OBTUSE “NOT-FOR-PROFIT” IDEOLOGY
    The NHS is hopelessly inefficient. So called “investment” has been used to “create” jobs that simply do not add value, diverting resources away from patient care. Patients would not miss the legions of barely anglophone admins, H&S officers etc. that have swollen the payroll. The NHS is NOT free. It is actually extremely expensive. At a cost of c. £120bn pa for 60m people it represents £2k pa in tax for every man, woman and child. Compare this cost, and the quality of care, to £200/month for private health insurance for a family of four. No wonder the public-sector unions don’t like the private providers. But the truth is, the unions don’t care about their members’ patients at all (even if their subscription-payers perhaps do). One wonders whether Lord Tebbit shopped around to get the best deal for his dog’s insurance? Or did he insist on a state monopoly with a political obligation to “create jobs”?

    4) CATASTROPHIC BADLY-NEGOTIATED POISON-PILL CONTRACTS
    Who on earth would have negotiated PFI contracts, paying way ABOVE the market rate, stretching for decades into the future, with their own money? ONLY THE STATE, WITH ZERO ACCOUNTABILITY, COULD GET AWAY WITH THIS.

    There is nothing for staff, tax-payers or patients to fear from private competition. Refereed by family doctors who know their patients’ needs better than anyone else.

    NHS staff who add real value should have nothing to fear from structural changes: patients will continue to marvel at the work they do and their talents will always be in demand.

    Much is made of the supposed “ideological” nature of austerity measures. But the fact remains that NHS spending is forecast to rise and the PM has committed to this again in the HoC only last week.

    What IS ideological is the prejudiced, politically-motivated, union-led, Luddite opposition to improvement, based on nothing but (misguided) self-interest, to the exclusion of patient care and with no regard for the tax-payer.

  17. Paul Gleeson

    Lord Owen: Government acting with "no authority" over NHS reforms | Left Foot Forward: http://bit.ly/gRfrLw via @addthis

  18. Carolyn Anderson

    Lord Owen: Government acting with "no authority" over NHS reforms | Left Foot Forward http://goo.gl/C0ISQ

  19. Wendy Maddox

    RT @leftfootfwd: Lord Owen: Government acting with "no authority" over NHS reforms: http://bit.ly/gy2ndz reports @LewSOSNHS's @Jos21

  20. Martin Rathfelder

    13eastie is deluded if they think they can get comprehensive healthcare insurance for £200 a month – to last a lifetime. The state provision of healthcare has its faults but they are as nothing to the problems of an insurance system.

    Competition and choice sounds great doesn’t it? But do you want to be asked in the ambulance where you are to be taken when you’ve had a stroke? In healthcare quality is difficult to measure. Price is easy.

  21. BenM

    I want some of what 13eastie is smoking as it is obviously pretty strong stuff!

  22. Steve Kelly

    If anyone really believes Lansley is or will listen, then they need to see a doctor. It’s more deception, lies and spin. All just smoke and mirrors in the hope no one will notice what they are doing behind everyone’s back.

    To say I hate this Coalition Government is an understatement I, and I’m quickly beginning to believe the only way to save out nation is by revolution. This sham of a democracy is no longer working. We need real democracy.

  23. 13eastie

    @2 I’ve been fortunate to have good health and I know that can’t be counted on forever. My premiums will probably rise (as surely as my motor insurance will continue to come down). My children will start paying for themselves one day.

    It is a sustainable system and a genuine market with value-for-money at its heart. It is the diametric opposite of the NHS. There is room in the system for the state to assure cover for those unable to pay. And there is the scope for development of a market sector that will pay money back to the exchequer in vast amounts.

    The NHS, by comparison, is a Ponzi-scheme that will eventually fail those who paid the most into it. Like other over-ardent stars, nothing will remain but a black hole called “pension liability”.

    I cannot speak for Lord Tebbit’s dog, but I can for mine. She has twice had complex surgery with negligible waiting time and no rationing of any investigation. I never had to worry about the cost or the quality of her care.

    I bet there’s a fair number of folk who’ve paid a lot more into the NHS than they have into pet insurance and got much worse treatment than their mutts…

  24. Mr. Sensible

    Someone needs to turn off the life support machine on this bill. And quickly.

  25. Mr. Sensible

    Oh and I don’t want any of what they’ve got in America thank you very much.

  26. 13eastie

    @7

    Good thinking! We could definitely cut down on NHS bills by not sending NHS consultants to the States to learn the latest techniques from Hugh Laurie.

    (BTW – you better go check your medicine cabinet in case there’s anything made by J&J or Pfizer).

  27. eindiainsurance

    Lord Owen: Government acting with “no authority” over NHS reforms http://bit.ly/hKiZFQ

  28. BenM

    13eastie – the US system costs twice as much as ours as a proportion of GDP and its outcomes in terms of coverage are much worse.

    That system is bankrupting the US.

  29. 13eastie

    @9

    GDP per capita in the US is more than $12,000 greater than ours.

    The reason they spend more than we do on healthcare is because they can afford to, and they arguably get more value-for-money than we do. Look up Ronnie Cohen…

    As far as bankruptcy is concerned, look closer to home: it is us and not them whose healthcare system is breaking the exchequer and it is us and not them whose “investment” has been made on the public never-never.

  30. Jos Bell

    @OwenJones84 woops – sorry – try this. http://bit.ly/dXroz2

  31. Jos Bell

    @richardblogger that's kind of fascinating ain't it?! http://bit.ly/dXroz2

  32. Jos Bell

    @13eastie
    Currently only 3% of the NHS spend involves private care – this is for several reasons involving duty of care, quality, capacity and social justice ideals. Also the overall repulsion for putting profit before the relief of pain and suffering. If you think you would find that your £200pa is a bargain, then just consider what your NI and tax contributions would do for you if you all found yourselves with high cost conditions – firstly you would find your policy did not cover said conditions, secondly in terms of the care offer, it is well known that the private sector ( dogs aside )does not have the capacity to deal with multiple and complex conditions, nor indeed, many acute and chronic conditions. Thirdly, your premium would rocket despite lack of capacity which would result in the public sector being left with such cases, but with a resultant declining capacity to deliver because of funding constraints. Postcode lottery will return with a vengeance – cherry picking on all sides, which may work for the better off and more mobile, but will create healthcare deserts in areas of low income/highest need, as well as leaving complex patients unable to access a GP list, to the overall detriment of our society.

    The Hippocratic ethos of putting the patient first and foremost would be completely undermined by the proposed model – the GP flagged by Lord Owen as saying a ‘penny in your pocket is a penny out of mine’ amply demonstrates the risk to patient treatment and then to mutual trust ( for be sure of one thing, patients are increasingly starting to understand this ). Under the model, within each consultation, GPs will have to take on board their duty to shareholders, as well as to Consortia members; then to the paradox of DOH funding – which will require cost savings for the following year as well as threatening penalties for missed outcomes ( so very difficult to measure ). Thus whether Mrs Jones has a bunion or a brain tumour – whatever the glossy sheen of patient choice, she will not be at the forefront of this ‘deal’. Such centralised market involvement also firmly inculcates our care packages with EU Competition Law, which is hugely complex, hugely costly and completely unnecessary for the smooth running of our health service. If this goes ahead, stay tuned for multi-million suits from private firms trying to batter the rump of the NHS into oblivion, leaving anyone who cannot afford insurance with little or no effective care. As for patient choice, that will be obliterated for such communities.

    Thus, an overall decline in England’s medical care and huge impact upon the population in terms of individual health, community health, public health and thence the macro economy. (please check out Marmot for added value analysis ).

    Those who wish to see the end of the NHS for statedly selfish reasons should think again – stay selfish if you will, but please understand that this bill will have a devastating effect upon England and then British society as a whole.

  33. Richard Blogger

    @13eastie I trump yout CT scanner with my MRI scanner (developed in Britain with public money at Nottingham University), anyway it is a daft argument, you can simply say “how many people will refuse to be operated with steel instruments because the Bessemer was developed by a capitalist”.

    Top down targets. They were successful with 18 week waiting times (do you *really* want to go back to the Tories 18 month waiting lists?). You mention Mid Staffs, but that was not caused by “top down targets”, the cost cutting there was due to the hospital voluntary trying to achieve FT status too quickly. The problem is that Lansley has set a top-down target that all hospitals must be FTs by April 2014 whether they are financially sound or not. hence we will get far more Mid Staffs in the next couple of years. As to your comment on “freely-competitive provider” it is irrelevant because no private hospital supplies A&E nor emergency admissions, but the majority of Mid Staffs were.

    “The NHS is hopelessly inefficient”, been drinking the Lansley kool-aid? The fact is that only international standards the NHS is very efficient. Saying that the NHS will not miss Health and Safety officers is bizarre. When you are in hospital H&S is vital. It was a lax attitude to H&S that lead to MRSA. I don’t know where you are getting your figures fro, but they are incomplete. From the NHS budget £5bn is spent on training (the private sector benefits from this so it is not included in your £200pm), £3bn is for public health. £1bn is for social care (Osborne raided the so-called “ringfenced” budget). About £20bn is for primary care (GPs) does your £200pm provide primary care?

    I am somewhat suspicious when people talk of Ponzi Schemes, its an acccusation I often hear from tea-baggers about all types of things. In fact the NHS is simply a health insurance scheme underwritten by the government. Your private health insurance is exactly the same as the NHS: many people pay in, fewer people get benefits. The difference between the health insurance from the NHS and your provider are three-fold:

    1) The NHS does not pay shareholders a cut of every premium payment.
    2) No one is ever denied coverage by the NHS. Everyone, regardless of their condition will be treated for that condition. Private health insurance companies will only insure the healthy.
    3) A competitive market in health insurance means that private companies have to aggressively market and have high costs of accountancy. In the US 35% of hospital budgets is spent on marketing and accounts. This is also true of US not-for-profit hospitals (which is half of US hospitals). Admin in the UK is in single figure %ages.

  34. 13eastie

    Thanks for the responses
    ___________
    @11 JosBell

    This is just hysteria. There is no reason for system capacity to be affected. The number of doctors in the UK will not change much, whomever they work for. The argument that public = more capacity, private = less capacity is nonsensical. Current funding arrangements have created vast swathes of unused capacity that would never be allowed in a privately funded system.

    As far as “putting the patient first” goes, I think you underestimate through ignorance the medical profession. Either that or you are scaremongering. They are a truly professional bunch, rarely in it for the money (which is not actually that great), and very tightly regulated. Visit any NHS hospital and somewhere you will find facilities being funded privately by the very doctors that use them. You clearly don’t understand how GP partners are remunerated currently if your claptrap about “shareholders” and suchlike is anything to go by.

    YOU WILL HAVE TO TAKE MY WORD THAT I HAVE SOME EXPERIENCE OF THIS AND I TRULY BELIEVE THAT THERE IS NO BETTER ADVOCATE FOR A PATIENT UNDERGOING HOSPITAL TREATMENT THAN HIS FAMILY DOCTOR. THIS IS NOT “IDEOLOGICAL”. IT IS PLAIN COMMON SENSE. GP’S CURRENTLY HAVE FAR TOO LITTLE INFLUENCE IN HOSPITALS.

    ___________
    @12 Richard

    Nottingham University? Is that the one Boots paid for?

    Waiting lists were not brought down by targets. They were brought down by huge, unfunded increases in spending.

    As I said earlier, Labour continually failed to consider unintended consequences. Without Labour’s top-down targets, how do you suppose ANY doctor would have come up with “stacking”?
    http://www.guardian.co.uk/society/2008/feb/17/health.nhs1

    MRSA has nothing to do with HASAW. This is a ludicrous (and ignorant) conflation. Your own skin is covered in S. aureus and no number of step ladder courses will stop it mutating.

    Yes, I accept your point re. primary care. Could certainly live with a 16% surcharge on premiums for GP cover, or else pay for consultations (like at the dentist) while the less able are state-funded.

    The Ponzi-scheme analogy is entirely valid. In the main (and policy relies on such generalisations), folk pay in while they work, so as to get care in their old age. They have no contract. They rely on new members joining the scheme to make it work for them. And on politicians to honour promises that were made before they were born. As soon as the geometry of the pyramid changes adversely, the people who paid in the most lose the most.

    An insurance scheme, by comparison, has no liability except to current subscribers.

    Re. admin % in the UK being in single figures, does this include all of HMRC’s costs, plus the cost to employers of running and collecting PAYE and NI (employers are effectively slave labour to the NHS).

  35. Is Lansley really listening? | Left Foot Forward

    […] list of those opposing these reforms continues to grow, and includes an ever increasing number of Lib Dems and Tories like Lord Tebbitt. They join a growing list of leading health […]

  36. Major

    This is not about “will eventually fail those who paid the most into it” and I don’t see what that ‘failure’ might entail, are you trying to suggest people won’t receive the care they need? Presumably everyone under a private system receives everything and more?

    The NHS is not about self,self,self, the modern mantra. It’s about safeguarding the health of the populace in general and protecting the right of said populace to medical aid without question or judgement. Paying into the system gives each of us our own slice of that guarantee.

    The Ponzi analogy is not valid, you have just twisted it to suit your argument. We pay into the system to ensure that ALL are covered today, not ME tomorrow. It is not an investment in individuals’ futures, it is society’s investment in itself. If you want to view it from an individual perspective you pay in today in case you fall ill today, you pay in tomorrow in case you fall ill tomorrow. As a society we decide that those of us who are more able to pay will extend our help to those who are less able, that means, among others, the elderly, we need to continue to encourage this attitude not discourage newer generations from it.

    It furthermore gives a greater national assurance to public health as government has a vested interest in it. Do we really want a system where our slippery politicos (of all varieties) have carte blanche to defer to a healthcare system with a vested interest in ensuring ‘throughput’?

    Healthcare is not a commodity, it is a basic human right. I’m sure many of the exponents of private insurance would think twice once faced with a situation in which they are seriously ill and find they are not covered or renewal of insurance is unaffordable.

  37. Beverley R

    I lived in America for 34 years, health insurance cost more than a mortgage payment and not many can afford it. Any pre-existing conditions and your lucky if you can get insurance period. People loose there homes and savings for treatment they hope will help them. Oh yes, they have fancy machines and up to date equipment and you can go into the emergency room with a cut on your knee that needs a couple of stitches and come out of there having had so many tests you can’t keep count and a bill for a few thousand dollars That’s what it’s like in America!

  38. So who backs Lansley's health reforms then? | Left Foot Forward

    […] Party, GPs, the 390,000 people who signed the 38 Degrees petition against the reforms, midwives, Lord Owen and, just for the record, Norman ‘get on your bike’ […]

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