One of the most pernicious aspect of the Tories' NHS reforms is one of the least known.
At present we have a National Health Service because the Department for Health (and it's Welsh, Scottish and Northern Ireland equivalents) all have a statutory duty to ensure that there is a health care service for all in this country free at the point of supply.
That will not be the case after Cameron's reforms go through. The Department for Health will ot have such obligation in England, at all.
GP consortia will have a legal obligation to provide services to those registered with them. But note, you have to be registered t enjoy the service. It will not be a right: it will only be a right if you are registered.
And there will not be an obligation on consortia to provide universal health care free at the point of delivery, quite extraordinarily. If a consortia decides it cannot supply a service because it is too costly or it has run out of budget then it will be able to decline to do so. GP consortia will not be an NHS: they'll be a selective healthcare service because they'll have a statutory duty to supply a service for which there will be increasing demand at ever reducing cost and that will necessarily mean they'll ration - which will impose impossible conflicts of interest on GPs.
And what for those who do not or cannot register with a GP consortia or who need the services their GP consortia cannot or will not supply? For them their health care supplier will be their local authority. Yes, it is local authorities that will have the duty to supply universal health care after the reforms come into effect.
Of course, local authorities have no mechanism to make those health care supplies. And nor are they being given any budget to deliver them. But you can already hear Cameron saying it's not his fault that they won't be able to deliver - it's their legal responsibility and if they fail it won't have anything to do with him.
Except of course it will. He, Lansley and Clegg are responsible for this reform. The reform will end the right to universal healthcare. And it signals the end of national healthcare - and brings in an era of supposedly local healthcare when there is no mechanism to supply it.
That's not chance: that's further evidence of designed in failure in the scheme the ConDems are proposing. And there's only one reason for that designed in failure: it is complete contempt for democratically controlled supply of services for the benefit of all the people of this country when what Cameron and his friends wan is the opportunity to capture control of those services so they can rake billions off them to enhance their personal wealth.
We don't have long to stop this deliberate act of destruction. And if the Lib Dems toe the party line we have no hope of doing so.
Will dogma destroy the NHS? I hope not - bit only vociferous action can prevent it. That I do know.
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This is literally unbelievable – a scandal, taking the provision of health in England (Scotland & Wales will presumably be able to by-pass this pernicious nonsense, and maybe so will Northern Ireland) back to the sort of system under the 1834 Poor Law. The ConDems really are Thatcher on speed or angel dust. I think a new Peasants’ Revolt is called for!
Isn’t the scariest part of the bill on page 33? “It is intended that the forth coming health bill will introduce provisions to limit the ability on the secretary of state to micromanage and intervene”. So if this bill does start the destruction of the NHS there is no way the government can intervene. Lansley is washing his hands of the NHS.
Amazing isn’t
“It’s not my fault”
I passed a law saying so
Richard. What might help is a response from Ed Miliband of similar tone, quality and honesty to this from Obama (against attacks on the Medicare system).
http://www.guardian.co.uk/world/2011/apr/13/obama-4tn-spending-cuts-deficit
By the way, over the time I’ve been reading your blog you’re recommended some excellent books. So here’s one from me that I don’t remember you mentioning: Tony Judt (2010), Ill Fares the Land. Any book that start with the line, ‘Something is profoundly wrong with the way we live today.’ deserves a read. Excellent.
Thanks
Will read
Richard
You probably won’t care too much about this, but if what you say is true, the reciprocal health agreement that we in Jersey have just got back after two years in the wilderness will not be worth the paper it is written on.
The wealthy bankers will be fine – they have private cover; ordinary working people in Jersey (and Guernsey) who need specialist treatment will get shafted. Heigh-ho…
To have rich, healthy politicians driving this programme is not the best way to do it. These people have suddenly realised they haven’t quite thought things through. So what do they do? They launch a 10 week listening exercise. Just as preposterous as the proposals in the first place. It’s a pimple on an elephant. The NHS has been serving this country to the admiration of the world for 63 years and it will take a little more consultation than that.
Much as I admire the aspirations of the early NHS, it is certainly not the case that it is today serving Britain to the admiration of the world. Many European populations without such a state controlled monolith are much better served with better facilities, shorter waiting times, better outcomes for serious disease etc. Perhaps the current changes proposed by the coalition are unwise; I do not pass judgement, but certainly fundamental change is needed. Much of the infrastructure lags behind that in other countries and the bureaucracy is sclerotic.
You clearly have not the faintest idea what you are talking about
The NHS is a() cheap b) has world class outcomes now as good as Europe and trending better and miles ahead of the USA c) spends a tony proportion of what the US does on admin d) does not over investigate like France e) had low waiting times although these are now getting worse due to Coalition action f) suffers enormous waste only because it is forced to behave like a market
Get your facts right
Then comment
I see a large part of the problem is that the labour party is not so much labour, as it is part of the body politic.
By that I mean that it too is mired by the corruption inherent in having to stop. friends and family as part of companies given contracts, not only in health affairs but other things as well.
I think the rot has gone too far now
http://healthandcare.dh.gov.uk/listening-exercise-how-to-get-involved/
Say something or read and feel better that everyone else feels the same. Probably won’t do much good. But please do say something, here on the ‘listening’ exercise or in writing or whatever. Please everyone. For my patients and for all current and future patients – be they you or someone you love or even someone you dont know yet
The NHS already rations care, particularly with treatments with high costs and lower levels of clinical benefit. There are already treatments you can’t get that would be beneficial because they are too expensive. The big difference is that at the moment NICE sets out what is cost effective enough that it should be provided and local PCTs held to account if they don’t provide it.