ANDREW LANSLEY, DAVID CAMERON and NHS REFORM: Simply Ideological Madness

Dear oh dear oh dear, Forests were a disaster; Michael Gove has upset the courts and many schools over his education reforms; but this one is the BIG ONE, the mother of all reforms and the one that if it goes wrong will affect every man, woman and child in this country adversely.

The NHS, is an institution that is loved by the many, and hated by the few.  It is in the population’s DNA for all its good points and it’s faults.

Before the election, David Cameron promised no big top down reforms of the NHS and that any reforms would be a part of “evolution” and not a “revolution”, after all, we are all on the same side aren’t we? Or should I say “we are all in this together”.

Today Ed Miliband had his best Prime Ministers Questions both technically and on substance today as he wrong footed Dave Cameron.  David Cameron was ready for an assault on the labour agenda on VAT and tax, and indeed managed to lever some of his homework into his answers so as not to waste his sweat and toil.  Sadly the big debate on the agenda was not VAT but the NHS, and unlike in previous weeks when he has accused Ed Miliband of sticking to pre-prepared questions, Dave Cameron was rooted to the spot with his pre-prepared answers.

Ed Miliband baffled his rivals and many journalists with his questions on the effects of EU competition laws on the NHS.  (This confusion is explained here in fact check this evening http://blogs.channel4.com/factcheck/bringing-competition-and-the-eu-into-the-nhs/6019)

Clearly the free for all opening up of the NHS to drive down costs will encourage profit making, bring bureaucracy into the surgery and drive health care toward the cheapest option and no the best.  After all it easy to measure cost, but not quality of care.

This will no doubt beef up the support for the Labour leader and satisfy some of those who have seen his somewhat lack lustre performances of late.

The real issue though is whether these reforms are advantageous for the NHS and how the government is going about introducing them.

Andrew Lansley must be one of the most ill prepared and underhand ministers of the past 30 years, which is quite an achievement baring in mind the competition. Even taking into account the recent competition from William Hague losing his mojo and being generally incompetent and Caroline Spelman’s total ineptitude in bringing forward the sale of the remaining forests in public hands, Andrew Lansley is pursuing a new record of incompetence.

THE NHS BILL

The bill is widely recognised to foist upon our health system the most far reaching reforms to be introduced to the NHS since 1945.  This is not to necessarily go against the reforms, but goes to show how important it is to
a) explain why they are needed
b) explain how the reforms will work
c) base decisions on facts and experience
d) listen to those who currently provide the service
e) provide evidence that they will work better than the NHS currently does.

On all of these measures, so far at least, Andrew Lansley and the coalition have failed.

Andrew Lansley was the shadow Health Secretary for 7 years prior to getting into government.  Which means he should know the job inside out.  He should have been explaining his proposals in depth and in detail to health professionals for several years, however he failed to do this.

There were virtually no discussions before the election of the NHS reforms either within the media or between electoral candidates.  The public therefore knew very little about them.  In addition, he did not tell GP’s all of his intentions or that PCT’s were being scrapped. Consequently it was a massive shock to GP’s when they found out and concerns have been raised. (Full Fact http://fullfact.org/fackchecks/NHS_reform_gp_commissioning_BMA-2561)

As GP’s are technically the one section of the NHS that should feel like they are gaining out of the proposals, it is odd they are amongst those so vehemently against them.

In addition, concerns have been raised when opening up the NHS to competition and GP’s choosing services for their patients that there is no provision in the bill to prevent conflict of interest, and GP’s buying services that they themselves have a financial interest in.  In other words, making money out of treatments. A recent interview with the health department could not answer this concern.

With regard to the reasons for the changes, we are told catagorically that “we cannot go on with business as usual”, that the NHS is the “sick man of Europe”, and that the NHS needs urgent reform because our cancer and heart disease treatment is terrible and the worst in Europe.  Andrew Lansley has consistently used statistics to make his point.

The problem is of course that the statistics he uses don’t back up his claims and sometimes actually show the opposite to his own arguments.  As discussed at length by Ben Goldacre here http://www.badscience.net/2011/02/andrew-lansley-and-his-imaginary-evidence/ and Fact Check here http://blogs.channel4.com/factcheck/factcheck-is-lansley-misleading-us-over-the-nhs/5993 and Full Fact here http://fullfact.org/factchecks/surviving_scrutiny_the_international_standing_of_the_nhs-1511 all confirm how Andrew Lansley and the Coalition government consistently mislead the public over these figures.

This is perhaps the most worrying aspect of this entire saga.  If a government wishes to make changes to a service that people have confidence in, they should be able to argue what is wrong with the service, BEFORE, enacting the changes so that people understand how these changes will affect them and make life better. It is worrying to say the least and rather sinister that the government is unable to make an argument for the changes in the first place and acknowledge that the Health service is actually in pretty good shape.

STATISTICS

Statistics have been used showing that Cancer rates are lower in other countries than in the UK.  But these statistics are compared with statistics compiled by Eurocare which health professionals accept are not complete and should not be used for political comparison.

Statistics are also shown for Strokes and Heart attacks to show how bad the NHS is and these can be confusing.  They show that some countries are better than the UK, but also that the UK has been improving at a greater rate than any other country in the EU.  Indeed if we extrapolate the improvements forward, some argue that the outcomes will improve beyond France within 2 years.

Below is from the Full Fact Team regarding cancer treatment:

The UK screens more women for breast and cervical cancer than most other developed countries and in the OECD’s 2010 Health at a Glance, we ranked third for cervical cancer screening and fifth for mammography screening over the period 2000 to 2008.

Survival rates, however, are less healthy. For both cancers, the UK dips below the European average – the 5-year survival rate for cervical cancer during 2002-2007 was 59.4 per cent – versus an OECD average of 65.7 per cent; and for breast cancer the rate was 78.5 per cent, slightly lower than the OECD average of 81.2 per cent.

But, the OECD points out that survival rates for different types of cancer is improving in the UK.

And data from the Office for National Statistics (ONS) rubber-stamps this; with latest figures showing that the UK survival rate for most of the 21 common cancers improved – for both men and women – over the period 2003-2007 compared with the period 2001-2006.

Furthermore, ONS stats show that the five-year survival rate for women diagnosed with breast cancer during 2003-2007 was 83.3 per cent. This was 1.3 per cent higher than for women diagnosed in 2001-2006

As for heart disease, the official Ministerial briefing for the Bill claimed that, despite matching the French for healthcare spending, our rate of death from heart disease is double theirs.

This claim was repudiated a few months ago by the Kings Fund’s chief economist John Appleby. He said the comparison was made over just one year of OECD figures, and with France – a country with the lowest death rate for “myocardial infarction” – or heart attacks – in Europe.

Mr Appleby pointed out: “Not only has the UK the largest fall in death rates from myocardial infarction between 1980 and 2006 of any European country, if trends over the past 30 years continue, it will have a lower death rate than France as soon as 2012.”

http://blogs.channel4.com/factcheck/factcheck-is-lansley-misleading-us-over-the-nhs/5993?utm_source=twitterfeed&utm_medium=twitter


The statistics are not the only story though, becasue no matter what the stats tell us, they do not prove that a) more or less spending produced the outcomes stated or b) that it is due to the way the NHS is organised, or indeed that the re-organisation of the NHS would improve things.

Confidence in the NHS is currently amongst the highest of any health service in the world, with the 2010 Health Policy Survey showing that the UK scored highest on confidence in NHS treatment and second only to New Zealand on the quality of care from doctors – with 79 per cent of those questioned rating the care they’d received in the past 12 months from their doctor as very good or excellent. (compares UK, Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the US.)

In addition in terms of value for money, if we compare with the US who recently had quite a scandalous debate about their health care system, we spend half as much as the US, and treat a far larger proportion of our citizens.

The BMA yesterday called for the Health Bill to be withdrawn and for a ‘halt to the proposed top down reorganisation of the NHS’. Another nail in the coffin of the Lansley argument.  http://www.pulsetoday.co.uk/story.asp?sectioncode=20&storycode=4128846&c=2

CONCLUSION

If we took any notice of Andrew Lansley’s rhetoric, and that of the Prime Minister and government, we would think that the NHS was on it’s last legs, was run by bureaucrats, wasted money and if you were ever admitted to hospital you were bound to die.  Sadly, (for Mr Lansley that is), this is simply not the case.

The Liberal Democrats finally discovered some backbone by voting against the reforms at the spring party conference at the weekend, but this will do little in reality as Nick Clegg has put his weight behind the reforms even claiming in a recent interview that these reforms were a part of the Liberal Democrat agenda of localism!

Not only has the case not been made; no mandate obtained; goes against advice from health professionals; ignores facts; but it will also cost billions of pounds.  As much as £3 billion.  At a time when we simply do not have the money, this seems highly irresponsible. http://www.telegraph.co.uk/health/healthnews/7894203/NHS-reforms-will-cost-3bn-and-will-not-work-academic.html

Does the NHS need improvement, of course it does, and it always will.  The challenges facing the health service over the next 50 years will be severe.  But to take a risk in the way the government is, spending billions in the process, for outcomes that cannot be determined, is irresponsible at best, and downright ideological madness at worse.

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