Debbie Abrahams MP, PPS to the shadow health secretary Andy Burnham and chair of the PLP health committee, looks at what Jeremy Hunt has in store for the NHS.
Debbie Abrahams MP (Labour, Oldham East and Saddleworth) is the PPS to the Shadow Secretary of State for Health and chair of the PLP health committee
During his spell as culture secretary he was roundly condemned for his partiality to News Corp during the BSkyB bid process, and narrowly missed losing his job. It will be interesting to see what Lord Leveson’s report says about Hunt’s involvement in this affair when he was supposed to have had a ‘quasi judicial’ role.
As far as the NHS is concerned, in spite of his apparent easy charm and cosy bedside manner, he is no friend of the NHS. The book, “Direct Democracy: An Agenda for a New Model Party”, which he co-authored in 2005 with, amongst others, Michael Gove and Greg Clark, called for the NHS to be dismantled, claiming it was no longer relevant.
In addition, Hunt declared earnings of £366,000 last year from his company, ‘Hotcourses’, which, until last weekend, hosted advertisements for Bupa and Virgin Healthcare on their website. It can’t be considered appropriate that a Secretary of State is associated with, let alone takes income from, such a company. Hunt should not have had to be told there was a conflict of interest when hundreds of NHS contracts have already been awarded to private healthcare companies including Virgin and Bupa and even more are currently out to tender. [See NHS Check, October 2012].
Similarly he seems not to recognise his comments on reducing the legal limit for abortion – whether personal or not – are not only contentious in view of his position but also make a nonsense of the claim his government’s health reforms are based on evidence.
Hunt’s objection to the NHS being in the Olympics opening ceremony is another indictment of his lack of personal commitment to and understanding about what the NHS represents – it is not just a healthcare organisation, it reflects the culture and values of our country.
As Hunt addressed the Tory Party Conference in Birmingham, all this was pushed to one side as he said how “proud” he was to be health secretary. Although he is in the process of advertising for someone to manage the NHS ‘brand’, he was as ebullient as he could be when he thanked ‘Team NHS’ for all they have done. It was no surprise to hear him promise to push ahead with the so-called health reforms – no mea culpa from this health secretary.
But, very neatly, he side-stepped his association with the PR disaster that is the Health and Social Care Act by packaging them as “Andrew Lansley’s reforms”. Unsurprisingly, Hunt is trying to detoxify the public’s opinion of them. In last week’s You Gov poll, 28% of people said they felt the Tories did not care sufficiently about the NHS.
But the public won’t be taken in a second time. They will remember their experience and the hollow promises to cut the deficit and not the NHS.
Just six months since it passed into legislation, the predicted impacts of the coalition government’s Health and Social Care Act are already starting to bite. As thousands of nurses and doctors are being laid off patients across the country are experiencing delays in or withdrawal of some treatments; for example, cataract surgery. [See NHS Check, June 2012].
Some services are being completely decommissioned for particular population groups; for example, primary care services for the homeless and other people not registered with a Clinical Commissioning Group. In a number of areas, patients also face the prospect of having to pay for treatments that until now had been free.
So, as predicted, through this Government’s Health and Social Care Act, the slow but irreducible erosion of the NHS’s founding principles of a universal, comprehensive and free health service is taking place.
In his speech to the Tory Party faithful, Hunt talked about improving quality. But he did not say that at the heart of the coalition government’s health reforms is their commitment to competition between the NHS and private healthcare providers, such as Virgin Care, Bupa etc. Hunt et al maintain that competition will bring improvements in the quality of healthcare.
However, the OECD’s 2009 review of international evidence of the effects of supplier competition on healthcare just does not support this. Applying competition principles to the organisation of healthcare in the same way that were applied to utilities such as gas and telecommunications doesn’t take account of the key differences between these sectors.
The NHS is tax financed, (largely) free with (currently) strongly regulated health professionals who because of the complexity of assessing healthcare quality usually act on behalf of their patients. Hunt may well say UK evidence from the ‘Patient Choice’ agenda suggests health outcomes improved with competition – to which there is a rather technical but nonetheless important reply.
In the hierarchy of scientific evidence, evidence from a review of international studies provides ‘stronger’ more reliable evidence of causation or association (or not, as in this case between competition and improvements in health outcomes), than single studies (particularly single studies of poor quality) such as that of the Choice programme. But I’m afraid a lack of evidence for what Mr Hunt wants to do to the NHS will not stop him.
Hunt talked about improving survival rates from the biggest disease killers, integrating health and social care and addressing the quality of care as well as treatment. No-one could disagree with any of these, although why was public health only mentioned once? This says a lot about Hunt’s commitment to helping us all not only live longer but live longer in good health.
How we tackle the issues Hunt mentioned is vital. The current healthcare reforms are working against making these improvements, fragmenting rather than helping to integrate services. I welcome Hunt saying he will implement Andrew Dilnot’s recommendations on adult care funding, but when? There is a care crisis now!
Although it wasn’t mentioned, I predict personalised care will be part of the Health team’s vocabulary very soon. In the same way that their privatisation of the NHS has been dressed up as competition, Hunt will talk about the importance of personalised healthcare, when what he will really mean is personal health budgets.
And they are not the same.
Personal health budgets (PHBs) have been operating in the Netherlands since 1997 and are currently being piloted here. However, although the Department of Health’s interim report evaluating these pilots suggests there are some positive outcomes to patients as they feel more independent and in control of their healthcare (similar to the experiences of people who receive personal budgets for adult care), many participants expressed concerns about the operation of the PHBs and felt anxious about future arrangements.
Lessons from the Netherlands leave more unanswered questions:
• What happens when the PHB is spent?
• Who picks up the bill – the NHS or the patient?
• Based on the Dutch experience, is it an efficient and effective way to spend the NHS’s budget?
• How will fraud and exploitation be prevented?
Most sinister is that PHBs under the auspices of personalising healthcare is the step needed to introduce an insurance-based health system – your PHB will be your insurance ‘premium’ – and the final step of Oliver Letwin and John Redwood’s 1987 seven-point plan to dismantle the NHS.
Labour’s position couldn’t have been made any clearer at our party conference last week. United and unequivocal, Ed Miliband, Labour Party leader, and Andy Burnham, shadow health secretary, both said: we will repeal the Health and Social Care Act, but without a top-down reorganisation.
As he launched a national policy review for an integrated health and social care system with a holistic, social model of health, Andy Burnham went a bit further: in his own act of mea culpa he said we didn’t get it all right when we were in government and promised to learn from this.
No, we didn’t – but I believe we’re on the right track now.
Debbie will be leading the PLP Health Inquiry into health systems’ effectiveness and resourcing linked to the national health policy review which is due to start in November.
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