Doctors’ union report condemns austerity drive that hits most vulnerable and drives inequality, poverty, and ill health
A raft of coalition policies threatens to have profoundly deleterious effects on children’s lives, driving widening inequalities and sending more families into poverty, according to a scathing report by the British Medical Association.
In the 250-page analysis, entitled Growing up in the UK, the BMA’s board of science delivers a sustained assault on government flagship policies covering welfare and health, warning that they are likely to hit the most vulnerable patients in the NHS.
The doctors’ union says that, despite the prime minister’s pledge to make his government the most “family friendly” ever, “the administration’s policies are unlikely to be described by health policy analysts as family friendly”.
The report says that cuts to child benefit, Sure Start centre closures, and regressive tax policies, have affected women and children.
This has occurred, it adds, at a time when there appear alarming trends for young people in society driven by poverty and inequality.
Extreme disparities include 250,000 children a year failing to meet a school standard of good development, such as the ability to speak, recognise words and dress themselves, the BMA reports. It says it is not acceptable to fail children on such a grand scale.
Even when the government has made the right noises about alcohol and cigarettes, it has drawn back from legislating for minimum pricing and plain wrapping for tobacco, the BMA notes.
Where ministers have acted on healthy eating, they have done so by co-opting the fast-food industry to tackle the spiralling rise in obesity, the group says.
Overconsumption of snacks, fizzy drinks and fast food has caused 20,000 children now starting school to be obese at the age of four.
But the BMA maintains that the government’s “responsibility deal on food” has at its heart a fundamental conflict of interest.
The BMA calls for the government to pull out of deals with big business over fast food.
“While the food industry has a role to play, this should be when a strategy is in place and regulations are being implemented.
“It is essential that government moves away from partnership with industry and looks at effective alternatives to self-regulation to ensure that there is a transparent and effective policy.”
Sir Albert Aynsley-Green, the first children’s commissioner and adviser to the BMA, said that more worrying still was the government turning a deaf ear to global evidence on health policy.
He pointed out that Canada had recently begun public information campaigns warning that drinking while pregnant increased the risk of brain damage and “the link to criminality” in the unborn child.
Aynsley-Green said: “I wrote to the chief medical officer about this issue, which is a live one internationally. She gave me the brush-off saying ministers were awaiting WHO guidelines. They are not taking it seriously.”
The BMA says rising levels of poverty and inequality will place enormous pressure on the NHS where “there are still significant numbers of children whose deaths are avoidable”.
Death rates from pneumonia, asthma, and meningococcal disease are higher in the UK than in comparable European countries.
“If the UK had the same all-cause death rate as Sweden around 1,900 children’s lives could be saved each year,” the report states.
The BMS report arrives at a time when there are fears over the gap between the number of paediatricians employed by hospitals and the number required safely and legally to staff existing acute services.
Doctors say that the coalition will have to take responsibility for the fallout of its policies.
The BMA warns that the most recent international studies place the UK 16th out of 29 nations in terms of child wellbeing – and that this “may not reflect the current situation … and does not reflect the impact of policies implemented post the 2010 election”.
Although Britain has improved from its position at the bottom of the global rankings, in 2007, the report says this advance could be “reversed … hitting the most vulnerable hardest, which would exacerbate child poverty and widen social inequalities”.
The authors say they found shocking details for a society that considers itself to be child-friendly.
They point out that the Department of Health’s own work in 2012 concluded that “more children and young people are dying in the UK than in other countries in northern and western Europe”.
It also highlights data published last month showing that the highest number of children ever recorded in the UK were referred to local authority care, mainlyover abuse and neglect issues.
The report calls for several measures, including parenting classes, improvements to maternal nutrition and policies aimed at children in need.
It also argues that measures are needed to create a more equal society as “current government austerity policies are predicted to cause child poverty to rise substantially”.
A government spokesperson said: “There’s a lot of misleading stories about the effects of our tax and benefit changes. The truth is, our welfare reforms will improve the lives of some of the poorest families in our communities, with universal credit making three million household better off and lifting hundreds of thousands of children out of poverty.
“And by next year we will have taken two million of the lowest earners out of paying tax altogether.
“Every child should have the same opportunity to lead a healthy life, no matter where they live or who they are. Working with a broad range of organisations we have pledged to do everything possible to improve children’s health.”
It could work, but poor implementation, GP disengagement and cuts threaten to smother this health service restructuring
Following the passage of a deeply divisive health bill, we are now in the middle of the authorisation of clinical commissioning groups (CCGs), the bodies that have been given the tricky task of making clinical commissioning a reality. Up and down the country, CCGs are putting forward their credentials and making the case to the new NHS commissioning board that they are ready and able to commission services for their local populations from April 2013. The board will be responsible for directly commissioning services worth around £20bn and for allocating more than £60bn to more than 240 CCGs.
Clinical commissioning, as a concept, is one that the British Medical Association (BMA) has been advocating for many years, as the merits of moving the control of services closer to patients and local clinicians are obvious. It could, if done properly, lead to an NHS that is more responsive to the needs of the local community, while empowering doctors to get more involved in shaping the services they deliver. Many doctors and other healthcare professionals have untapped experience and talents that could be harnessed for the benefit of patients.
Unfortunately, this proposed new dawn has already been tarnished by the protracted passage of the health bill and the ongoing financial squeeze that could mean there are fewer services available for CCGs to commission. Many GPs are concerned that they could become the administrators of NHS cuts as they are handed responsibility for decimated budgets. The NHS Act 2012 gives CCGs the authority to decide to whom they will provide a service, and what service they will provide. They will be under no obligation to ensure that a whole range of services are available to their catchment population. (There is already rationing of services such as hernia, cataracts and hip or knee replacements). The NHS Act also enables CCGs to enter into joint ventures with private companies to outsource most work to private companies with vested interests, beyond the scope of full public scrutiny.
It is a factor that the government refuses to address despite it looming over the entire clinical commissioning process.
This worrying mood has been worsened by a number of practical problems emerging on the ground during the early stages of the authorisation phase, particularly with CCG constitutions which will decide how each CCG will operate. GPs are reporting back to the BMA that some GP practices are being pressured into signing constitutions at short notice with barely any time to check how their practice, and patients, will be affected.
Others are flagging up that many GPs have a lack of basic information which has left them bemused about the whole process. Government pronouncements about how its reforms will involve doctors more in planning healthcare will fall totally flat if rank-and-file doctors are left scratching their heads on the sidelines. Participation rates among GPs in many CCGs is already reported to be low.
There is still time to make clinical commissioning work, but it is in real danger of becoming smothered by a toxic combination of poor implementation, GP disengagement and NHS cuts. This represents a real first challenge for the new health secretary, Jeremy Hunt. He must take action urgently to address the implications of the rushed authorisation phase that could undermine the whole project. And on funding, he must show his mettle by fighting to protect the NHS budget so that CCGs do not simply become the vehicle for cutting back our health service.
Time will tell whether Hunt is willing and able to meet these challenges
• This article presents the author’s personal views and not those of the BMA
Mark Porter, the new British Medical Association’s chair of council, says cuts and rationing of drugs may harm patients
The NHS is putting patients’ health at risk by denying them drugs and operations because of growing rationing being imposed to save money, the new leader of Britain’s doctors has warned.
The drive to meet demanding efficiency targets is so serious that the NHS is offering some GPs surgeries extra money if they send fewer patients for tests and treatment in hospital — a move condemned as “morally wrong” by Dr Mark Porter, the British Medical Association’s recently elected chair of council.
In his first interview since taking up the post Porter said the NHS was offering fewer and fewer services to patients and that many had been “cut out”, often against doctors’ wishes.
The shrinking of the NHS’s “offer” to the public was being hastened by the coalition’s health reforms, creeping privatisation of services and the system’s need to save £20bn by 2015, Porter claimed, in remarks that are likely to irritate the health secretary, Andrew Lansley.
Those pressures mean the fear that a patient may be harmed because they are denied a test or treatment “is a realistic concern”, said Porter. The same changes, especially the growing number of private firms providing NHS services, also threaten to fragment the health service by making it less of an integrated system and have a severe impact on recent improvements in the quality of care, he added.
The NHS has come under growing criticism for making it harder for patients to have operations for routine conditions such as hernia, cataracts, grommets, wisdom teeth, or hip or knee replacement, and denying infertile couples IVF.
Rationing of access to certain procedures deemed not worthwhile by the NHS, which is still piecemeal and localised, will soon become much more widespread as the spending squeeze in the service tightens, said Porter. “You see it happening in examples now, but it’s when it becomes service-wide in a few years’ time, if the current policies continue, that the population will notice in the wider sense.”
NHS organisations’ lists of treatments they will no longer pay for mean that “bits of the NHS are being parcelled off and taken out of the NHS offer year by year”. Although the NHS constitution guarantees universal and comprehensive healthcare “there’s lots of areas where bits of the NHS have been taken out of the offer”, Porter said. “It’s no longer a comprehensive service. We can see the effect of people to whom we have to say: I’m sorry, this treatment is no longer available.”
The use of referral management centres, in which family doctors’ decisions to refer a patient to hospital are analysed by a third party before any treatment can be given, “are particularly distressing for GPs who know how they would like to deal with patients but find their ability to do so is more constrained than ever before”. The situation was in stark contrast to “rhetoric” from ministers about how patients and GPs are being given more power than ever before as a result of their changes to the NHS in England, Porter added.
Both existing NHS primary care trusts (PCTs) and the clinical commissioning groups (CCGs) led by local GPs that will replace them next April are offering GP practices money in return for sending fewer patients to hospital to receive what can be expensive care there, despite NHS leaders and ministers having told them to restrict access only on clinical, and not financial, grounds.
For example, Harrow PCT in north-west London has offered local GP surgeries up to £4 extra per registered patient if they “optimise the use of outpatient appointments to reduce the inappropriate variation in referral rates across Harrow practices”, among other measures.
The PCT has to save £14.2m in the current financial year in order to meet targets set as part of the Department of Health’s “quality, innovation, productivity and prevention” cost-cutting drive. It has written to practices proposing to pay them £1 a patient if they appoint a GP who will review all their colleagues’ referrals before they are approved and another £1 of the £4 a head if the 25% which refer the most patients to hospital cut that by 10% “where clinically appropriate”.
Porter said that while the BMA supported schemes to improve the quality of referrals, such offers potentially gave GPs a conflict between their clinical judgment and personal self-interest, as GPs who run a practice can decide either to spend income on improving services or use it to boost their salaries. “It’s morally wrong and professionally wrong. Paying a direct financial incentive like that can be a direct financial incentive to the person themselves and that incentive shouldn’t be there. Doctors’ minds should be on what’s best for the patient, not on whether the PCT will sub them for certain types of financial behaviour,” he said.
The Department of Health said last night it would stop PCTs and CCGs from offering GPs such deals. “If patients need treatment, they should get it when they want it and where they want it. If local health bodies stop patients from having treatments on the basis of cost alone then we will take action against them,” it said.
In a broadside against some of the coalition’s main health policies Porter also warned that the introduction of “any qualified provider”, which from this autumn will force PCTs to let private firms provide NHS services in 25 different forms of treatment, would destabilise local NHS services by deliberately creating a market where none currently exists.
In addition, some centres offering both trauma and orthopaedic surgery were at risk because the orthopaedic service was being opened up to competition from private firms, he said.
Letting hospitals raise 49% of their income in future from private patients ran the risk of hospitals neglecting both NHS patients and patient safety because many would be too busy trying to exploit new-found commerical opprtunities, he added.
Andy Burnham, the shadow health secretary, said: “When the leading doctor in the land warns that the government has put the NHS on a fast track to privatisation then it is time for people to sit up, take notice and rally to its defence. The N in NHS is now under sustained attack.”
But the DH rejected Porter’s fears over rationing. The Department of Health said: “The NHS is treating more people and we are increasing the NHS budget in real terms. The NHS made £5.8bn in savings in 2011-12 while keeping waiting times low, performing more diagnostic tests and planned operations. It is showing it can meet the financial challenge set.”
Dr Mark Porter is preparing to clash with the government on two fronts: doctors’ pensions and the future direction of the NHS
The new leader of Britain’s doctors names Nye Bevan, the chief architect of the National Health Service, among his political heroes, suggesting he is probably not the biggest fan of the coalition’s hugely controversial NHS shakeup.
Dr Mark Porter describes his personal politics as “progressive, liberal, left as opposed to right, though not dogmatically so” and himself as “somebody who is imbued with a sense of social justice, rather than having the economic imperative ruling everything – a Guardian reader as perhaps opposed to a Telegraph reader.”
The health and social care bill saga and doctors’ dispute over their pensions resulted in regular TV and radio appearances by Porter’s predecessor as the British Medical Association’s chair of council, Dr Hamish Meldrum. With the pensions issue still unresolved – on 21 June it prompted the first industrial action by medics since 1974 – and concerns rising about the NHS’s ability to withstand a cash squeeze, rising demand and a fundamental reorganisation all at the same time, Porter’s low profile will not last long.
As the voice of the doctors’ union, which has 140,000 members, Porter, a 50-year-old consultant anaesthetist in Coventry, faces two main challenges.
First, he has to somehow extract some concessions on pensions from a government that has played hard ball on the issue. Doctors, he says, “remain hugely upset” at ministers’ “arbitrary” decision to push through big changes to an NHS pension scheme that generates a £2bn annual surplus and was reworked in 2008 to make it sustainable.
Second, he has to win a battle for the hearts and minds of the public against the health secretary, Andrew Lansley that will only increase in intensity until the next election in 2015.
The growing pressures on the NHS, its unique place in British life and its significance to all three main parties’ prospects in 2015 mean the public will be able to choose between the very different Porter and Lansley visions. Neither claims the NHS is in a crisis. Both agree the NHS in England is doing surprisingly well given that more people are seeking its services just when it is facing flat budgets after the long years of Labour largesse, the job of delivering £20bn of efficiency savings by 2015 and the upheaval of yet another restructuring.
Lansley paints an optimistic picture of stable waiting times, patients’ greater choice of where to have treatment driving overdue improvements in quality of care, and groups of GPs taking charge of commissioning £60bn of healthcare from next April – the centrepiece of his reforms – benefiting doctors and patients. In his view, the bill was painful medicine the NHS had to swallow in order to help it provide better value for money, give patients greater control and use competition to drive up standards. Porter, by contrast, is worried. He fears that what he repeatedly calls the NHS’s founding principle of “social solidarity”, the concept of it as “good for society [and] a comfort and security for society”, is being eroded by a combination of growing rationing of treatment, greater use of competition, more and more NHS services being provided by private firms and the service’s struggle with the biggest cash squeeze in recent history.
The imminent requirement for “any qualified provider” to be allowed to provide services such as physiotherapy and children’s wheelchairs will threaten the future of existing NHS services and enable firms such as Virgin Care to make further inroads into the NHS’s £110bn budget. Porter worries that an NHS run for 64 years on the basis of “social solidarity” is being replaced by one which is “a series of transactions rather than a service that holds together”. He asks, why deliberately create a market in health services in an area when none currently exists?
As he sips a Diet Coke in his office on the third floor of the BMA’s grand headquarters near Euston station in London, Porter draws a series of ideological faultlines with coalition policy. Greater competition is not just unwelcome – the BMA wants to retain an NHS that is both publicly-funded and publicly-provided – but also “unnecessary because there’s no particular evidence that having a system which is pluralist – part-private – is necessarily better.” Forsaking the principle of social solidarity would mean that “you end up in a system like the United States, which many British doctors look at with a degree of trepidation”.
That is a dramatic, arguably fanciful, comparison from a man who rarely seems to lend himself to florid, exaggerated prose. The UK and America’s health systems could not be more different. Porter’s argument is that, if certain damaging policies are allowed to continue, the NHS could end up resembling its counterpart across the Atlantic, where access to healthcare is not universal, citizens cannot necessarily access every kind of treatment and where charges creep in.
Denying patients access to operations or drugs their GP believes would benefit them means that already “there’s lots of areas where bits of the NHS have been taken out of the offer [and] it’s no longer a comprehensive service”, he says. Taking aim at ministers’ repeated professed aim of maintaining the NHS, this passionate advocate of the health service adds that despite its constitution guaranteeing comprehensive, universal healthcare “the idea of social solidarity is gradually being chipped away at, by the actual actions which are said to be supporting the continued existence of the NHS.
“The BMA is not blessed of a special forecasting ability. But we are made up of most doctors who work in the NHS, which is how we see what’s happening. It’s not that [the BMA believes] the entire system’s going to fall over in a few months. But it’s quite apparent that the nature of the offer to the public is changing and the pace of change is picking up under the dual impact of the current reforms and the spending restrictions.”
Porter was born into a working class, Newcastle-under-Lyme family in 1962 and was the first member of his family to go to university – “like Neil Kinnock”.
He is fond of quoting Labour veteran Denis Healey’s dictum that every politician needs a hinterland. His, according to BMA News, includes “a love of classical history, particularly that of the Roman empire, science fiction and political dramas”. The last of those should stand him in good stead for the inevitable tussles ahead.
Commons health select committee warns drinks firms to do more to tackle the damage to health that their products cause
Tough curbs on alcohol advertising and a possible ban on drinks companies sponsoring sporting and cultural events are needed to reduce the 6,500 deaths a year caused by drinking, MPs say today.
The Commons health select committee also warns drinks firms to do more to tackle the damage their products cause or risk being seen as “paying only lip service” to the need to reduce the “insidious and pervasive” health effects linked to drinking too much, which cost the NHS more than £3bn a year.
Existing restrictions on TV advertising should be applied more widely, especially in cinemas, to stop ads encouraging under-18s to drink, the cross-party group of MPs recommends in a review of the coalition’s alcohol strategy.
They say “serious consideration” should be given to reducing to 10% the proportion of a film’s audience that can be under-18 and still allow alcohol to be advertised, or to prohibiting alcohol advertising in cinemas altogether except when a film has an 18 certificate.
The report tells the industry it needs to behave more responsibly and criticises spokespeople who “often appear to argue that advertising messages have no effect on public attitudes to alcohol or on consumption. We believe this argument is implausible.”
It adds: “Those involved in advertising alcoholic products should accept that their advertisements contain positive messages about their products and that these messages are supported by considerable economic power.”
If ads did not work, shareholders would not sanction spending on them. As such “it is important that the alcohol industry ensures that its advertisements comply in all respects with the principles of corporate social responsibility”, they say.
The MPs welcome the industry’s willingness to address alcohol-related harm, especially through health secretary Andrew Lansley’s “responsibility deal” under which drink and food firms pledge to tackle alcohol misuse and obesity in return for avoiding any new regulation.
But producers “aren’t entitled to brownie points” for their involvement, said Stephen Dorrell, the committee’s chairman and former health secretary under John Major.
“It’s simply part of the responsibility of being in a free society: as members of a free society and selling the produce they should be interested in the fact that six and a half thousand deaths a year are related to alcohol consumption, and should be doing something to bring those deaths down. They have to accept responsibility for the trade they carry on,” he said.
Ministers should undertake a “serious examination” of the possibility of introducing a version of the Loi Évin, passed in France in 1991, which bans alcohol advertising on TV and in cinemas, and stops drinks producers from sponsoring cultural or sporting events. Such a move would stop the industry from associating itself with football and rugby teams and competitions, such as the Carling Cup and Guinness Premiership rugby.
The MPs want Public Health England, the new government agency, to commission a study of the law’s impact on public health in France, and also an independent evaluation of the responsibility deal.
The MPs welcomed the government’s embrace of minimum unit pricing of alcohol, a move backed by many medical bodies. The fact that Scotland is doing the same and setting the price there at 50p a unit means “practical arguments” favour the same price in England in order to deter a cross-border drinks trade. But evidence does not support the coalition’s proposed ban on alcohol multibuys and such a move would risk antagonising the vast majority of people who drink responsibly, the MPs say.
The British Medical Association backed the idea of a UK equivalent of the Loi Évin as part of a crackdown on alcohol advertising. “In Britain alcohol is associated through advertising with social success, often implied sexual success and often also with sporting success, through sponsorship. That’s the link we have to break”, said Dr Vivienne Nathanson, the BMA’s director of professional activities. Improved labelling and shorter licensing hours were also needed, she added.
Sir Ian Gilmore, the Royal College of Physicians’ adviser on alcohol, welcomed the possible adoption of measures such as those in the loi Évin but said more action was needed to “tackle the growing problem of marketing through digital, online and social media, to reduce children and young people’s exposure”.
However, Henry Ashworth, chief executive of the industry-funded Portman Group, denied drink ads are irresponsible. “It is entirely prohibited for alcohol to be marketed or targeted at under 18s and this is strictly enforced through industry codes of practice,” he said. It was “deeply disappointing” that the committee had not recognised the value of the industry’s pledge to remove 1bn of the 54bn units of alcohol sold every year by introducing more lower-strength wines and beers by 2015, he added.
The Advertising Association also rejected the MPs’ concerns. “The committee’s call for ad restrictions doesn’t add up. We already know the suggested measures don’t work. Eight years after its introduction, the French parliament and anti-alcohol campaigners labelled the loi Évin ‘ineffective’ and ‘weak’ in reducing high-risk drinking,” it said in a statement.
“Strong UK regulation already demands that advertising avoids appealing to under-18s and our exposure rules are strict and effective. Of course problems remain, but government figures show consumption, harmful drinking and binge-drinking are all in decline. People in ads only ever drink responsibly, more of us are following their lead”, it added.
Emergency medical care will continue, but British Medical Association members will postpone non-urgent cases
Doctors will take industrial action on 21 June in a dispute over pensions, the British Medical Association has announced. Its members will provide urgent and emergency care but will postpone non-urgent cases.
The doctors voted for industrial action for the first time since 1975 to protest against the government’s planned shake-up of their pensions.
The British Medical Association (BMA) said separate ballots of six branches of its 130,000-strong membership, including GPs and hospital consultants, had produced an overall majority in favour of action, on a 50% turnout.
The union is proposing that doctors would continue to provide all urgent and emergency care during any industrial action, in order to safeguard patients’ welfare. Instead, their action will involve postponing non-urgent work, such as outpatient appointments, for a 24-hour period, either once or twice.
The vote sets up a major confrontation with ministers, who have given little ground over the BMA’s strong complaints that the government’s proposal will force doctors to contribute more to their pensions, work longer, and receive less in retirement on a career-average scheme instead of a final-salary one.
The BMA’s ruling council met to discuss the implications of the ballot, which closed on Tuesday night.
The BMA asked its members two questions: are you prepared to take part in industrial action short of a strike, and are you prepared to take part in a strike?
Doctors in five of the BMA’s six branches voted by resounding majorities in favour of both courses of action, with only the 41 occupational-medicine doctors who voted bucking the trend. Among 17,561 GPs who voted, 79% backed industrial action short of a strike and 63% endorsed strike action. A total of 18,721 consultants voted 84% in favour of the first option and 73% in favour of the second.
Among the 3,476 staff, associate specialists and specialty doctors who took part, 87% backed action short of a strike and 77% a strike. The 12,060 junior doctors gave the fullest backing to strike action, with 92% endorsing action short of a strike and 82% – the largest majority – saying they were prepared to strike.
The vote among 391 public health and community health doctors followed the same trend of smaller majorities for an outright strike, with 75% saying they would be prepared to take action short of a strike and 60% indicating their readiness to take part in a strike.
The last time doctors took industrial action was in 1975, when consultants suspended goodwill activities and worked to contract over a contractual dispute, and junior doctors worked to a 40-hour week because of dissatisfaction with the progress of contract negotiations.
The BMA argues that higher-paid NHS staff already pay proportionately more for their pensions than most other public sector workers, a disparity it said increased in April when their contributions went up, and which is set to rise again.
By 2014, some doctors will have 14.5% deducted from their pay for their pensions, compared with 7.35% for senior civil servants on similar salaries, to receive similar pensions, said the BMA.
Doctors currently at the start of their careers would be hardest hit, having to pay hundreds of thousands of pounds extra – double what they would have paid – in lifetime pensions contributions, according to the association.
NHS Employers, which represents major health service organisations such as hospital trusts on employment issues, warned that action by doctors would upset patients and could mean their treatment was delayed.
Dean Royles, director of NHS Employers, said: “They know that any industrial action will impact on care and cause distress and disruption to patients and undermine trust and confidence in the medical profession. We know that doctors are anxious about changes to their pensions. But no one wants to see patients dragged into the argument.”
John Hanratty, national head of public sector pensions at law firm Pinsent Masons, said: “In many health professionals’ minds, the reform of the NHS pension scheme is inextricably linked with the government’s health reforms. Anecdotal evidence is that many think that the reform of the NHS pension scheme is the government’s way of punishing the professions for opposing the changes to the health reforms.”
Private sector firms reluctant to bid for NHS 111 contracts, while BMA voices serious concerns
A 24-hour patient helpline being trialled by the Department of Health to replace NHS Direct has led to more ambulance callouts and potentially lowered the standard of care for children, doctors claim.
Although some private sector firms have refused to bid for the contract, feeling it is unworkable, the Department of Health plans an April 2013 launch for the national 111 service – a free one-stop number for patients with urgent, but not life-threatening symptoms.
The helpline is being organised with local franchises, but Capita, one of the biggest government providers, has pulled out from tendering, saying it had not been “constructed in a manner that will result in cost effective services”.
NHS Direct employs more than 3,000 staff, 40% of whom are trained nurses, but the replacement will be staffed by call handlers, who will have as little as six weeks’ training. This lack of medically trained staff will lead to more referrals and poorer outcomes, especially for vulnerable patients, say doctors.
The British Medical Association’s conference of family doctors last week passed a resolution saying GPs had “serious concerns about the design and precipitous introduction of the 111 model” and that the “government is ignoring the lessons from evaluations of 111 pilot schemes”.
Mary McCarthy, a GP from Shropshire who is part of a doctors’ co-operative Shropdoc, said the first four pilot schemes showed that ambulance dispatch rates were three times as high in these areas. “That’s treble the costs. Also, we see evidence of poorer care to children.”
She said some children who should be seen by a doctor were not getting help. “You get good outcomes when systems are clinically triaged with a medical professional or medically trained person dealing with patients. Not when you work to a computer algorithm where a lot of patients don’t fit into a flowchart. Children, older patients, mental health … it does not work.”
The government said a full evaluation of the pilot would be published later this year. The health minister, Paul Burstow, said: “NHS 111 is being introduced to make it easier for people to get the healthcare advice they need or to get to the right healthcare service first time – 24 hours a day, 365 days a year.
“Local NHS organisations are working with GPs and other clinical professionals to decide who should provide their local 111 service. Providers could be ambulance trusts, groups of GPs, NHS Direct or private providers – whoever will give the best service for patients and the best value for money for the taxpayer.
“NHS 111 call advisers have to complete a six-week training programme which is exactly the same training as 999 operators. They are supported by nurses who work alongside them in the call centres, and nurses will always be on hand to take over if the caller needs to speak to someone with clinical skills.”
BMA offers scathing assessment of Andrew Lansley’s plans, warning of creep towards privatisation of commissioning
Profit-driven firms may oust GPs from their key role in deciding what treatments patients need because of creeping privatisation in primary care caused by the coalition’s NHS shakeup, doctors’ leaders have warned.
The British Medical Association (BMA) said on Thursday that the relationship between family doctors and patients would suffer irreparable damage and that the reforms would be “irreversibly damaging to the NHS”, in its most strongly worded criticism yet of Andrew Lansley’s radical reorganisation of the NHS in England.
The BMA denounced the health and social care bill as “complex, incoherent and not fit for purpose, and almost impossible to implement successfully, given widespread opposition across the NHS workforce”.
The doctors’ union’s views are its widest-ranging and most scathing intervention yet in the controversy around the bill, which ministers hope will become law within weeks.
The criticisms come in a letter to 22,000 family doctors from Dr Laurence Buckman, the chairman of the BMA’s GPs committee. They reflect both the hardening opposition to the bill among medical organisations and, especially, the growing view among GPs that Lansley and David Cameron’s repeated promise that GPs will be the key decisionmakers in healthcare as a result of the changes are a sham.
The letter hints at the possibility of GPs pulling out of clinical commissioning groups (CCGs) – the groups of doctors which will replace NHS primary care trusts from April 2013 – by urging them to take “an active stand” to thwart reforms that, in the BMA’s view, would prove ruinous.
Buckman’s key criticism centres on the future role of the organisations which will provide commissioning support services (CSSs) to CCGs in the reformed NHS. “These bodies will initially do some or all of the ‘back office’ functions, but we fear that, in time, they could become the de facto CCG management. CSSs will be required to be outside the NHS as ‘freestanding enterprises’ and in a market of commissioning support for CCGs as ‘customers’, by 2016 at the latest,” he writes.
“We believe that this will lead to the privatisation of commissioning, destroy the public health dimension to commissioning, with a loss of local accountability to local populations, and is likely to exacerbate health inequalities.”
In a fresh appeal for the government to abandon the unpopular bill, Buckman said the BMA would co-operate with efforts to advance the introduction of clinically led commissioning in a non-legislative “alternative way forward” that would build on and spread good commissioning practice.
Andy Burnham, the shadow health secretary, called the letter “a devastating critique of the government’s plans. It takes them apart, piece by piece. This illustrates the government’s irresponsibility in ploughing on, if they don’t listen to this. Dr Buckman is saying that as the profession is overwhelmingly against [the bill], when so much of the reforms depend on the profession, [continuing with the bill] is dangerous,” he said.
Doctors were realising that Lansley had made empty promises when he pledged to put them in charge from April 2013, added Burnham. “What we are hearing from GPs, and Laurence Buckman articulates it very well, is that they have been given a false prospectus by the government. At the very beginning the idea was that it would be doctors in control and the more they have seen about how the government is implementing its reforms, the more doctors have felt uneasy and seen that they have been set up to fail.”
Buckman’s letter also raises another concern – that CCGs would not have the freedom GPs were initially promised. Smaller medical groups supportive of the reforms, such as the National Association of Primary Care and the NHS Alliance, have voiced the same fear recently. Some CCG leaders fear the planned new NHS Commissioning Board, which will oversee the newly-ordered health service from next year, is doing too much to proscribe what they can and cannot do.
Buckman’s letter says: “The NHS Commissioning Board, through a new network of bureaucracy, is directing operations from the centre. CCGs do not have the freedom to do much, as their personnel are being proscribed along with their commissioning support services, their structures defined, and their budgets are too small for them to function without uniting into very large and remote units. The ability for ordinary GPs to change things will diminish.”
The Department of Health dismissed the BMA’s move. “The BMA’s GPC seems to ignore the fact that thousands of GPs covering 95% of the country are already getting on with commissioning and improving care for their patients. Patients are being treated in more convenient places, pressure on hospitals is reducing, and we are safeguarding the NHS for future generations,” said Lord Howe, the health minister.
“Without the bill we couldn’t remove layers of bureaucracy and reinvest £4.5bn into frontline patient care. And the independent NHS Future Forum [launched last year as part of the government's NHS 'listening' exercise] found broad support for the principles of handing power to doctors and putting patients at the heart of the health system,” Howe added.
But the Royal College of Nursing, which like the BMA wants the bill abandoned, said: “Today’s letter is yet further evidence of the sincere and honestly held concerns that so many health professionals now have about the future of the NHS. Like the BMA, we fear that increased competition could lead to patient care becoming fragmented and that the bill is a huge distraction from the real issue of protecting and improving services at a time when the NHS in England needs to save £20bn,” said Dr Peter Carter, the RCN’s chief executive.
“We remain convinced that these reforms could damage the very system they were designed to improve and that the outcome will be increased health inequalities. The government needs to act on these concerns and introduce some stability into the NHS as a matter of urgency.”
Ballot on strike over NHS pension changes will be first time doctors have voted on industrial action since 1975
The British Medical Association has decided to ballot doctors for industrial action over the government’s reform of the NHS pension scheme.
The ballot will be the first time that doctors have voted on such action since 1975.
The decision followed an overwhelming rejection by doctors and medical students of the “final” offer on pensions.
The BMA said the changes would see younger doctors paying more than £200,000 extra over their lifetime in pension contributions and working eight years longer, to 68. The highest earning doctors’ contributions would rise to 14.5%.
Officials have urged the government to reopen talks with the health unions, but said neither the Treasury nor the Department of Health had signalled any change to their position.
The health secretary, Andrew Lansley, has said the NHS pension scheme is “amongst the best available anywhere”.
But a survey of 130,000 BMA members in January found almost two-thirds of the 46,000 who responded said they would be prepared to take some form of industrial action if the government did not change its offer.
The BMA formally became a union in 1971, and has only taken industrial action in 1975, when consultants suspended goodwill activities and worked to contract over a contractual dispute.
Leaders of a teaching union rejected the changes to public sector pensions on Friday, in a further blow to the coalition’s hopes of ending the long-running dispute.
The executive of UCAC, which represents thousands of teachers, headteachers and lecturers in Wales, warned that the option of further strikes remained open.
The union leaders, meeting in Aberystwyth, said they wanted to negotiate further with the government, and would step up their campaign alongside other unions to press for improvements to the offer.
The general secretary, Elaine Edwards, said: “We consulted with members before coming to a decision, and the message has come back loud and clear: the government’s offer is totally unacceptable and teachers and lecturers are prepared to take further action to secure a fairer deal.”
British Medical Association urges health secretary to slow down implementation of non-emergency number to allow for proper assessment
The British Medical Association (BMA) has written to health secretary Andrew Lansley over concerns about the implementation of the NHS 111 24-hour non-emergency phone service.
The letter, written by Dr Laurence Buckman, chair of the BMA’s GPs committee, expresses “serious misgivings” about the roll out of the NHS 111 service.
“Our key concerns include specific problems in some of the pilot areas, failure to ensure a smooth transition or to address the impact on existing services, fitness for purpose of the new service, value for money and local sensitivity,” Buckman wrote.
NHS 111 is being piloted in in seven primary care trust areas: Central Lancashire, County Durham and Darlington, Nottingham City, Isle of Wight, Lincolnshire, Luton and Derbyshire County. The service is due to be rolled out nationally in April 2013.
An evaluation of the pilots by the University of Sheffield is due to be published this spring. The BMA said it was also is concerned that the new service was being developed without a proper assessment of the pilots and adequate input from local clinicians, however.
The tendering process for providers is already under way, but the BMA said this was being rushed through. It is calling for a more flexible deadline so that fledgling clinical commissioning groups (CCGs) can play a full role in procurement decisions.
Buckman commented: “GPs have been telling us for quite some time about problems with the way the NHS 111 is being rolled out and the wider impact it could have on the health service.
“For example, in Shropshire, GPs are worried that patients will actually receive lower quality care as the clinicians who triage all calls to their out-of-hours provider are to be replaced by non-clinicians when NHS 111 takes over.”
He said that a flexible deadline would allow local commissioners to work out a solution with NHS 111 and ensure the best option for their area.
Public health minister Anne Milton said: “We will consider the BMA’s concerns. We agree that any long-term decision should be made with full approval from local commissioning groups. They should be fully engaged with the approach to delivering NHS 111.”
Jo Webber, director of the Ambulance Service Network, agreed with the BMA’s concerns about NHS 111. “A headlong rush to implementation will not necessarily benefit patients. It is vital to have buy-in first from clinical staff and future clinical commissioners,” she said.
“This takes time to develop and the initial results from the pilots suggest that NHS 111 is really delivering where strong working relationships have been in place for some time.”
This article is published by Guardian Professional. Join the healthcare network to receive regular emails and exclusive offers.