Posts Tagged ‘NHS reforms’

by Professor Allyson Pollock, professor of public health research and policy at Queen Mary, University of London

The Health and Social Care Bill 2011 represents the biggest threat to public health for 60 years and it is time for the public health community to stand up and say so.

Deliberately conceived as an ‘Abdication and Abolition Bill’, the proposed legislation would sever the duty of the Secretary of State to secure and provide comprehensive healthcare throughout England.

Entitlements to health care are to be abandoned in order that a consumer market can be substituted for a needs-based system and, in David Cameron’s words, the NHS turned into a “fantastic business for Britain”.

As these briefings to the House of Lords show, the Bill will destroy the public health foundations of comprehensive healthcare and the ability to gather information and monitor inequalities.

Geographic administrative units – the hallmarks of the NHS – are to be abolished. Whilst commissioner populations will be made up from GP registrations, GP boundaries are being dissolved.  Patient enrolment and disenrollment will lead to unstable denominators and render fair service allocation and planning impossible.

No-one will have ultimate responsibility for ensuring everybody in a geographic area gets access to a GP. Above all, the ability to monitor equity of access within a comprehensive system will be undermined by lack of data and local variations in entitlement.

Public health will be shunted out to local authorities but the resources, functions and services that will go with it are not defined.  It is even impossible to tell the populations for which it will be responsible.

Local authorities and clinical commissioning groups will have enormous freedom to decide what they will and won’t provide and the boundaries between chargeable and non-chargeable services will be blurred and subject to local eligibility criteria.

In place of equity will be service and patient selection by commissioners and service providers intent on managing the financial risks of the marketplace.  Commissioners will be allowed to outsource their functions to healthcare companies that specialize in these techniques.

The marketisation of healthcare will lead to the denial of care on a scale not seen in England since pre-war days.

At a minimum the Bill must be amended so as to restore all the Secretary of State’s duties and functions and the structures of a national public health service.

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by John Middleton, Vice-President of the Faculty of Public Health

The results of our latest member survey show despair, uncertainty and distress about the NHS reforms. We share members’ anger and frustration, reflected in feedback from local boards and committees. The results articulate the possibility of a wholesale departure from the specialty and major risks to the protection and improvement of the public’s health and the services they receive.

Wordcloud: Adjusted responses (phrases/themed/categorized), first 200 responses (max 50 phrases)

Credit: Andrew Hood, using wordle.net

Wordcloud: Adjusted responses (phrases/themed/categorised), from the first 200 responses in the survey (maximum 50 phrases)

As peers continue to debate the reforms, attitudes of public health professionals, and FPH’s leadership, are hardening. Faced with a government which does not seem to value professionalism or standards, it is essential that we continue to fight for the standards, accreditation and regulation of public health. No-one else will – and our partners in the public health national lobby agree with our stance.

Members have broadly supported this direction of travel – until now.  The ignorance and disregard in high places of what public health is and has done over 40 years in the NHS is alarming. FPH continues to hold a strong expectation for:
•    An independent and robust Public Health England;
•    A coherent career and training structure for public health professionals;
•    Protection of terms and conditions of staff;
•    Directors of public health reporting to chief executives of councils,
•    Clarity in the size and applications of the ring fenced budget and
•    Professional regulation for all public health specialists.

These issues were met with welcome support in the House of Lords committee stage.  However, a substantial cadre of our members believe that the public health community must campaign more explicitly against the likely negative health impacts if the reforms go through unchecked.

The Secretary of State has had a duty to ‘provide and secure’ the NHS since it began.   NHS planning has historically relied on regulations and guidance, not legislation.  This enables the NHS to move forward if the Secretary of State is in charge. If not, every line of the Health Bill becomes crucial.

Hard-pressed local authorities will only do what they must by law CCGs also will only do what they are required to do in law. The health system becomes a giant free-for-all; everyone doing the least possible, or the most lucrative and pocketing taxpayers’ cash. Some services may be deemed ‘bad business decisions’ and not be provided.

Where will these be without the Secretary of State’s duty to secure? This is a health insurance versus public health model. It calls into question the ideal of public service with which most of our members entered the NHS. Everyone in public health and health service users should be concerned about that.

As part of this debate, we have invited a range of organisations to contribute to this blog.  It remains open for members’ comments and more formal critiques. We look forward to your contributions here and through your local board members and FLACS.

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