David Cameron is to rally behind his health secretary Andrew Lansley and insist that the coalition will force its health and social care bill on to the statute book despite growing opposition within the NHS and the Conservative party.
As the Lords return to the bill on Wednesday, the reforms are likely to dominate prime minister’s question time at lunchtime.
Cameron is expected to quash speculation that Lansley’s future in the cabinet is in doubt, after an unnamed No 10 insider was quoted as saying he should be “taken out and shot”. The briefing was described as unauthorised, but No 10 acknowledged it may have taken its eye off the ball, allowing opposition to the bill to re-emerge.
Cameron and Lansley have met within the last 48 hours to discuss tactics. There is widespread frustration inside Downing Street at the way in which the professions were brought on side, but then slipped from the coalition’s grasp over the past two months.
Cameron is to undertake a series of NHS events next week, and is said to be confident that opposition to the bill in the Lords, at report stage, will be overcome. He is determined to set up the battle as one between a bureaucrat-run NHS and a doctor-run NHS.
Some of the most controversial sections in the bill on competition are unlikely to be completed until late March, by which time the local election campaign will be under way.
The shadow cabinet has agreed to include dropping the bill and NHS closures in its local election campaign themes.
Grassroots pressure for the Liberal Democrats in government to take a tougher line may surface at the party’s spring conference starting on 9 March.
Andrew Burnham, the shadow health secretary, accused ministers of having “abjectly failed to build a political and professional consensus behind the bill”, which he believed could still be stopped.
“All around the consensus is building that it’s better for the NHS to work back through the existing structures than to carry forward with this dangerous, wholesale reorganisation,” he told the BBC Radio 4 Today programme.
“I will work with the government to introduce GP-led commissioning, I’ve no objection to that at all, but as people from all quarters are now saying, this bill will damage the NHS at this particular time. It’s the wrong thing for the NHS, the wrong reforms at the wrong time and they should drop the bill.”
Burnham expressed concern about the potential effect of full competition on the health service. He said Labour had introduced an element of private provision to drive down waiting times, but this had been done in the context of a “planned, collaborative system”, with just 2% of operations carried out in the private sector by the end of its term in office.
“We had an NHS that was a collaborative NHS providing good standards of care and the question I keep coming back to is why on earth are the government turning it upside down. They inherited a successful, self-confident NHS and in just 18 months have turned it into an organisation that is demoralised, destabilised and fearful of the future.”
Lord Owen, the former SDP leader, took the unusual step of suggesting NHS staff had been misled into believing Cameron’s election guarantees on the NHS because his late son Ivan had been disabled.
He wrote on his blog: “David Cameron should remember the words he spoke about the NHS during the election. Most of those who work in the health service were aware of his own late son’s illness and felt that when he spoke about the NHS not having any more top-down reorganisations, he carried the conviction of someone who had real experience of what the NHS represented in British life.”
He said Cameron was the only person who could abandon the bill, saying if he did so “the NHS would heave a collective sigh of relief and next day start to implement, under existing legislation, those aspects on which there is widespread agreement”.
Cameron’s staff were privately angered by Owen’s remarks, but refused to comment.
Pressure also mounted on the Lib Dems, with Nick Clegg accused by Labour of “abject betrayal” over his support for Lansley’s bill.
The Labour deputy leader, Harriet Harman, claimed in the Commons the reforms would pave the way for NHS hospitals to earn up to half of their income from private work, putting NHS patients “at the back of the queue”.
Clegg defended the changes, saying the alternative to reform would be to “condemn a number of hospitals into outright financial crisis”.
At least nine Lib Dem MPs have signed an early day motion demanding that Lansley be forced to publish an independent risk report carried out into the reforms, which critics claim warned that the planned changes to allow GPs to commission health services on behalf of patients would lead to a surge in costs.
Senior Lib Dems expect the Lords to inflict defeats on the coalition over the bill, but even opponents are not expecting a rebellion as strong as that against the welfare reform bill last month.
Speaking to the House magazine, Clegg appeared to recognise dissent in his own ranks, saying: “Let’s be blunt: I’m asking, day in, day out, Liberal Democrat peers to vote on things that they wouldn’t do in a month of Sundays if it was a Liberal Democrat government.”
Clegg also praised Lady Williams, one of the bill’s strongest critics in the Lords, claiming that as a result of her intervention the bill was “a whole lot better than it would have been otherwise”.
The reforms have come under fire from an unprecedented coalition of critics, including the Royal College of GPs, the British Medical Association, the Royal College of Nursing, the Royal College of Midwives, and a joint editorial by three influential health journals: the British Medical Journal, the Nursing Times and the Health Service Journal.
More than 90% of those who voted in a British Medical Journal poll believed the planned health reforms should be scrapped. Of 2,947 votes cast on bmj.com over the last week, 2,706 said the reforms should be dropped while 241 said they should stay.
The former Tory cabinet minister Lord Tebbit is among those with reservations about parts of the legislative plans.
But he said the NHS inherited by the coalition was in need of “urgent treatment” and many of the health unions and associations had self interests in their opposition to the bill.
Writing in the Daily Telegraph, Tebbit rallied to Lansley’s defence, arguing his reforms deserved “a fair wind”.
He concluded: “To do as Lord Owen would have us do, and wreck the bill and run away from the consequences, would be an irresponsible surrender to self interest masquerading as the public interest. It will be a year or two before we can reach a verdict on every bit of the Lansley bill, but his reforms surely deserve a fair wind.”
guardian.co.uk © Guardian News & Media Limited 2011
How Cameron’s NHS cheats waiting-list figures
Public Sector Pages | NHS News, Public Sector News | February 21, 2012
David Cameron blocks his ears to inconvenient NHS truths, conferring only with supporters. Journalists are barred from hearing what staff tell him on his photo-opportunity hospital visits. Tuesday’s Guardian poll shows how far he has lost the public trust he tried so hard to win on the NHS.
He should meet Carol, who has just quit after 17 years as a waiting-list clerk. She got in touch to express her disgust at what she was ordered to do. When she protested to a senior manager, he said this was happening around the country, so I won’t reveal her hospital, unfairly picking on just one. This foundation trust boasts on its home page: “In these days of patient choice, it is more important than ever before to listen carefully to the views of our patients.” But their patients’ views might be unprintable if they knew how far political imperatives have overridden and warped medical priorities.
The national target says 90% of patients must be treated within 18 weeks of first referral by a GP. With annual budget cuts of 4% for the next four years, that’s a tall order as the NHS undergoes its greatest ever upheaval. Just to survive, the NHS always needs 2.5% above inflation, so most professional observers think it will erupt: already 18-week waits are up 43%. Waiting-list clerks are at the sharp end where the cash crunch meets the impossible target – and here’s what Carol says she was ordered to do:
She was told to cancel operations for anyone who was already waiting over 18 weeks, and instead to fill that theatre time with people closest to breaching the 18-week limit. “I was told to call people who had already gone over the 18 weeks and pretend there was no longer theatre time for their operation, and not give them a new date.” She was told not to book anyone already in breach until April and the start of the next financial year, or to book only one for every nine still under the target. Instead she was told to fill theatre slots with as many short, minor operations as possible.
Next she was told to use devious means for knocking people off the waiting list. The worst was when she was told to call a mother of three young children to offer her a short-notice slot for Christmas Eve, knowing she would refuse and so could be knocked off the list for refusing. “We would offer operations at very short notice to people getting near the 18-week deadline. You hope they’d say no so you count them as a refusal and knock them off.”
She protested first to her line manager, then to the one above and finally to the one above that. “I said I wanted these instructions in writing before I would lie to patients. Of course they said it could never be written down. But the manager in charge of operating theatres said other hospitals were all doing it, so we had to too. There’s no other way to stay within target.” Did the consultants know? “One complained, really upset at not getting patients seen according to priority of need, but they bullied him and he was told to be quiet. They warned that Monitor inspectors would put us on alert.”
Cameron’s new ban on mixed-sex wards after a long Daily Mail campaign has made matters far worse. He boasts that mixed-sex wards are now virtually gone. Carol’s hospital trust boasts the same on its front page. She says: “Take rheumatology. People come in for one day for injections for pain, with a session once a month. Now it has to be men one month, women the next. Sometimes there might be just four men, say, and the other places are wasted. Many have to wait two months not one month now.” This is what happens when political gimmickry is put before health need.
When Labour was driving down waiting times, there were similar stories of gaming and tricks: some A&E departments roped off corners and called them “wards” to keep within a four-hour trolley wait. “There was a bit of it then,” Carol says, “but nothing, absolutely nothing, like what’s happening now. I started in the early 1990s when there were two-year-long waits, and I’ve seen them drop so fast in the past 10 years. Now managers are deciding lots of patients are ‘not in clinical need’. But a builder who can’t work waiting for a hernia operation is in need, isn’t he?”
Carol was so shocked she walked away after registering her complaint. In her last weeks she was allowed not to phone her own 18-week waiters and cancel their operations – but, she says, “everyone else still had to do it”. “Clinical need is forgotten. It’s all about managing the figures now.”
Professor John Appleby of the King’s Fund health thinktank says he hears of waiting-list cheating from many hospitals and will suggest the National Audit Office investigates. The government on Monday claimed credit for figures showing A&E use is falling due to better GP commissioning. Appleby says it has nothing to do with a GP system not yet in place: the last government began fining A&Es treating too many people, so hospitals now channel more patients straight into annexed GP clinics – good practice, but nonsense figures.
Targets always tempt statistical massaging, but the extremity of this cheating means no waiting-list figures can be trusted. As the NHS enters a period of austerity that the former health secretary Stephen Dorrell says no other OECD health system has tried, honesty is essential. Doctors and managers do their best, but if asked the impossible they must say so openly and transparently. Voters deserve to know the truth. So, whistleblowers, please get in touch.
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