On last night’s Question Time health secretary Andrew Lansley was told to his face by a GP exactly why no one trusts him on the NHS.
Fellow panelist Dr Phil Hammond confronted him about the obsession with competition in the health and social care bill – and the almost complete absence of a mention of transparency, opennness, accountability, cooperation, compassion, integration and collaboration. The word competion appears 86 times – about 86 more than the rest put together.
Here’s a transcript of the exchange:
Phil Hammond: “This all depends on trust, and the profession is deeply suspicious when a government comes in and says they’re not gonna perform a major top-down reorganisation of the health service and then lands 353 pages on you…
“It’s absolutely impossible to understand it… It is unreadable… This is unreadable, there’s no narrative, there’s no convincing story, you would think if you would read that you would hear words like transparency, opennness, accountability, they’re not in there. How many times do you think the word competition appears in your health and social care bill?
“The version I have, I know there’ve been 17 versions since, but this one, how many times do you think the word competition appears?”
Andrew Lansley: “I, I…”
PH: “86. How many times do you think the word cooperation appears?”
AL: “Oh, it appears…”
PH: “Nought. Integration?”
AL: “It appears, there is a duty in the…”
AL: “There is a duty in the legislation, there is a duty in the legislation for integration of services…”
PH: “There are 86 competitions, four cooperations, no integration, no collaboration…”
AL: “Integration is in the bill…”
PH: “It’s not in the one here.”
As you will see, later in the dialogue Hammond explains in detail why the obsession with competition is wrong:
“The thing that worries people most about it is this element of competition. What the NHS needs above all, it needs to rediscover its humanity, there are lots of areas where the NHS is very good, but if you look at Mid Staffs and cases like that there is a real problem.
“The problem with competition is that in every instance we’ve tried competition in the past – and Labour did this and introduced a market into the NHS – the competition came in and cherry picked the easy cases.
“In the NHS, 20 per cent of patients take up 80 per cent of the resources, and the patients who need it most, the cherries, with five or six diseases – I can see patients here I’d say ‘oh you’re fairly fit, I’ll cherry pick you’, there are patients here who I’d think ‘golly, you’ve got five or six diseases, you’re a bit expensive, I’m not so interested in you’, the only way to solve the problems of the NHS is to integrate it, to absolutely focus relentlessly, love and compassion and the best service on the most sick patients.
“Now if you introduce a market into that it’s very difficult to get that level of integration when you splinter it up with competition, and although Andrew will say there’s been a change in here that will it’s never happened yet, and simply NHS workers don’t trust competition to improve collaboration, what they want is collaboration and integration, keep as many patients out of hospital as you can.”
We will have more on the health reforms, and the battle to save the NHS, later today and this weekend on Left Foot Forward.
• Ten reasons peers should vote against Lansley’s anti-NHS bill – Shamik Das, October 12th 2011
• Can Lansley be trusted with the NHS? 400 more experts say NO – Shamik Das, October 4th 2011
• Cameron’s fantasy list of NHS reform backers – Shamik Das, September 7th 2011
• So who backs Lansley’s health reforms then? – Dominic Browne, June 1st 2011
• Under the microscope: Lansley’s private healthcare supporters – Tamasin Cave, January 19th 2011