The NHS Reforms - A Letter to Jeremy Hunt
Another letter to my MP, this time about the NHS privatization. And, predictably, a disappointing response.
On 12 September 2012, I again wrote to my MP, Jeremy Hunt, who is now Health Secretary, challenging him on the evidence that the reforms of the NHS will be both worse for patient care and less efficient than the existing system.
Here's my original request, and his reply.
[My address redacted]
Rt Hon Jeremy Hunt MP House of Commons London SW1A 0AA 12 September 2012
Dear Mr. Hunt,
As a constituent, I wrote to you some five years ago now on the subject of your support for homeopathy on the NHS. Now you are minister for health, I would like to ask you some additional health-related questions.
Will you comply with the Information Commissioner’s order (from March 9 this year) to publish the transition risk register for the Health and Social Care Bill?
You will be selling off various services from each NHS trust to private providers. How will you ensure that the price paid to the exchequer for these services is appropriate, and does not represent the transfer of public assets to private companies at an unrealistically low price?
What is your evidence that this will result in efficiency savings and better service to consumers? When the internal market was introduced, internal administration in NHS trusts rose from approximately 6% to 12%, representing a decrease in efficiency. The US healthcare market has admin costs in the region of 30%. This seems to me to indicate that fragmentation of services results in a decrease in efficiency.
According to the Royal Society of Medicine’s study, the NHS already delivers one of the most cost-effective health systems in the world. How will you ensure that requirements for private providers be set to maintain this level of efficiency, and not decline to the level of the US system?
We have already seen how rail privatisation has resulted in increased cost to the taxpayer in subsidy, while at the same time also resulting in year-on-year over-inflation fare rises. I believe that similar effects are a real risk as health assets are similarly privatised. How will the government be monitoring spending and delivery? Will you be publishing the criteria for success before selling off the assets? Only by making the required standards open and transparent ahead of time can we ensure that they are met.
What measures are in place to re-acquire assets from providers who fail to deliver appropriately?
With the removal of centralised service providers (e.g. NICE’s service of drugs testing and certification), this means that each trust now has to at least partially duplicate this function. How is this efficient or in the patient’s interests? Does this not just create a “postcode lottery” where the provision of healthcare services depends on the commissioning preferences of your local trust?
What measures are in place to ensure levels of care are adequately safeguarded? A single company (or group of companies) gaining a monopoly over a particular service would be particularly damaging, as this would remove the element of choice from the patient or referring doctor, and would allow the company complete freedom to set prices.
In January 2013, all medical services in particular fields will be nationally commissioned. As far as I can see, this effectively mandates the exact conditions required to create the monopoly problem. How will all provision for, say, Tier 4 Child and Adolescent Mental Health Services being in the hands of a single, for-profit service provider be in the interests of the patients it serves? Since privatisation is supposed to engage the benefits of competition, how does a single central private provider differ from a single central state provider? This move would take money away from care budgets as profit and move accountability from the voters to the shareholders.
How will appropriate standards for care be maintained under the “any qualified provider” scheme? The qualifications seem rather flexible, and what guarantees are in place to prevent, for example, an anti-vaccination group bidding for and running vaccination services?
That penultimate question brings me back to my original point from 2007. Do you still stand by your response at that time, that homeopathy “ought to be available where a doctor and patient believe that a homeopathic treatment may be of benefit to the patient”?
I am looking forward to reading your reply.
Mr Hunt's Reply
''I didn't get a reply from Jeremy for a while, as he was on holiday. (Fair enough - we all have holidays.) He replied in an email dated 12 October 2012, as follows:''
Dear Mr Ellis
I have recently received the attached letter from my colleague Earl Howe in the Department of Health about the modernisation of the NHS.
Firstly in relation to the disclosure of the risk register we continue to exercise the ministerial veto. This reflects our view on where the balance of public interest lies in this case. It is important to have effective risk management procedures in place across the Government and disclosing risk registers could put this in jeopardy.
Secondly the modernisation programme is not about selling off assets. Independent, voluntary and private organisations have always been part of NHS services. What is important is that care will remain free at point of use and based on need and not ability to pay. We need to modernise the NHS to make sure it is fit for the future and able to adjust to the ever changing health care needs of the population.
I hope that the attached letter from Earl Howe answers all your questions and if there is anything else that I can help you with please let me know.
Rt. Hon. Jeremy Hunt MP Member of Parliament for South West Surrey Secretary of State for Health
Earl Howe's Response
This was presented as a scanned PDF of a fax - the IT equivalent of printing it out and taking a photo - so I have had to retype it. Any errors or omissions are mine, and I will correct them if (when!) they are discovered.
Department of Health Richmond House 79 Whitehall London SW1A 2NS
From the Earl Howe Parliamentary Under Secretary of State for Quality (Lords)
[ref number redacted]
The Rt Hon Jeremy Hunt MP House of Commons Westminster London SW1A 0AA
Than you for your email of 21 September on behalf of your constituent, Mr Sean Ellis of [address redacted] about the modernisation of the NHS.
I shall address Mr Ellis's points in order.
We continue to exercise the ministerial veto in relation to the disclosure of the transition risk register. This reflects our view on where the balance of public interest lies in this case; in particular, the need to protect a 'safe space' within which officials can formulate sensitive advice to ministers. Our decision, backed by the Cabinet, demonstrates the importance that the Government places upon effective risk management procedures across government, which the disclosure of risk registers could put in jeopardy.
The modernisation programme is not about selling off assets. Independent, voluntary and private organisations have always been part of NHS services. For example, most GPs are private contractors, and the medicines that the NHS buys are manufactured by private companies. What people say matters to them most is the quality of care they receive and that they receive it for free when they need it.
In the new NHS, competition between providers will be a means, not an end, to empower patients and staff, to drive up responsiveness, outcomes and efficiency, and provide the best value for money for taxpayers.
Key to this will be the new economic regulator, Monitor. It will promote choice and competition to ensure that all providers can compete fairly and transparently, and it will have powers to address any anticompetetive behaviour in order to protect the interests of patients and taxpayers.
Patients will continue to have a choice of who provides their NHS services. Patients will be able to choose an appropriate provider based on information about the quality and accessibility of those services. Providers from all sectorsm including NHS trusts, social enterprises and the independent sector will continue to have a role in providing NHS services. The key criteria will be whether they can deliver the service to the standards set out in the National Standard Contract, whether they are registered with the Care Quality Commission, and whether they can deliver the service for the price the NHS is willing to pay.
With regard to efficiency, by the end of this Parliament our changes will result in potential savings to the NHS of £4.5billion, all of which will be re-invested in patient care. There will also be indirect potential cost savings, through improved commissioning, more appropriate and effective care, and reduced costs of provision.
On tackling health inequalities, I would like to reassure Mr Ellis that we respect the expert independence of the National Institute for Health and Clinical Excellence (NICE) and believe its role is vitally important to the NHS. NICE will be at the heart of work to improve quality in the NHS. This is why we are re-establishing it as the National Institute for Health and Care Excellence with an extended remit covering adults' and children's social care.
The NHS Commissioning Board will be free to make decisions about how best to allocate NHS funding without Government interference. Its focus will be on achieving equal access to health services designed around the needs of the patient, for which it will be rigorously held to account by ministers. The Commissioning Board will publish a commissioning outcomes framework for clinical commissioning groups (CCGSs). It will be held to account for delivering improved patient outcomes instead of top-down process targets. The Commissioning Board and CCGs will have to report each year setting out their assessment of how they have performed.
The Health and Social Care Act 2012 reflects our view that specialised and very highly specialised services, which are currently commissioned either nationally or regionally, are best commissioned at a national level by the NHS Commissioning Board rather than locally by CCGs.
Ministers will retain responsibility for deciding what services the Board should be asked to commission. However, it will be the responsibility of the Board to decide how it commissions those services. The services that the Board will directly commission will be set out in regulations.
Offering choice of any qualified provider is a way of commissioning service that enables patients to choose - where appropriate - any provider that meets the necessary quality requirements, price, and the terms and conditions of the NHS standard contract. Potential providers of NHS services will undergo a qualification process, which will ensure that all providers offer safe, good quality care, taking account of the relevant professional standards in clinical services areas.
Finally, decisions on the provision and funding of homeopathic treatment will remain the responsibility of the NHS locally. A patient who wants homeopathic treatment on the NHS should speak to his or her GP. If the GP is satisfied this would be the most appropriate and effective treatment then, subject to any local commissioning policies, he or she can refer them to a practitioner or one of the NHS homeopathic hospitals. In deciding whether homeopathy is appropriate for a patient, the treating clinician would be expected to take into account safety, clinical and cost-effectiveness as well as the availability of suitably qualified and regulated practitioners. The Department of Health would not intervene in such decisions.
I hope this reply is helpful.
Disappointment, and head-desk interface at the claim that "The modernisation programme is not about selling off assets". I will expand on this later. For now, enjoy fisking the above.