Better Health For All

by Dr  John Middleton and Dr Corinne Camilleri-Ferrante
(writing here in a personal capacity)

Since before Christmas, women have been concerned by the revelations about faulty implants used in breast surgery. There has been much debate about whether or not these should be removed and, if so, who should foot the bill. The expert committee convened under Sir Bruce Keogh, Medical Director of the NHS, reported Friday 6th January. However, many Faculty members fear the issue is just one small example of what might happen on a larger scale if the changes to the health service now  going through Parliament proceed without proper risk assessment/ challenge.

The revelations of multiple failures, of manufacture, regulation, and responsibility, should make Peers consider the facts very carefully. The government proposes a vast increase in private provision of health care just as we are told that existing private providers are unable to supply adequate records of what they have been doing and are charging women for information on what happened to them.

There is complete confusion about who is responsible for putting things right, except that we know it is not the manufacturer, which has ceased trading. Private companies are citing ‘commercial confidentiality’ as a reason for not producing data. Yet, Peers are now being asked to endorse a Bill that may increase the risk of such events occurring without being able to see the government’s risk register.

The Bill will lead to further fragmentation of data collection, as the Faculty has said, and contains no clear failure regime for private providers. This will be even worse than the failed data collection which meant that the Independent Sector Treatment Centres established by the last government were unable to provide data to assess whether they were providing value for money, or even complying with the terms of their contracts.

This has just been one example of the failure of private provision with a  requirement for the NHS to pick up the pieces, as local authority care has had to step in with the Southern Cross disaster. Such examples show how services  provided by the taxpayer are then required to divert their resources from other pressing needs. And there is little come back for the private citizen, the patient, caught in the middle of this failure.

There is also an additional cause for concern. The Secretary of State for Health was interviewed about the breast implant issue on Radio 4’s Today programme Wednesday 4th January.  Under current legislation and under a clause that has stood since the beginning of the health service, the Secretary of State has a duty to secure, and to provide comprehensive health care for all.

In the new Bill, this Duty to Provide will be removed. The Secretary of State will be able to disclaim responsibility and say that it is the responsibility of each Clinical Commissioning Group that authorized their use. The Secretary of State has been  reduced to exhorting  private providers to fulfill their moral duties but has no  authority to  make them.  If the Health Bill becomes law, who will then be interviewed on the Today programme, stand up and be counted and admit, ‘the buck stops here?’