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Letter to MP Regarding NHS Reforms

In NHS, Politics on April 9, 2011 at 1:51 pm

Below is a letter I wrote to my MP on 24 February 2011. I published it on Facebook in the hope that people may use some or all of it as a template to write to their own MPs. I now publish it here too, in the same hope.

Some of it is now slightly out of date – the committee stage is now over.  Rather than pressing on to the report stage, David Cameron and Andrew Lansley have decided to slow things down for a ‘listening exercise.’ In order to make them actually listen, rather than just appear to have done so, we must continue the pressure on them.

The first part of the letter is from a template written by the British Medical Association’s Junior Doctors Committee (BMA JDC). The second part was written by me.  Feel free to quote from any of the letter to construct your own.


Dear ______,

As your constituent and a local doctor, I am writing to bring to your attention the concerns I have about the Health and Social Care Bill.  You will be aware that the Bill, which had its Second Reading in the House of Commons on 31 January 2011, proposes to radically reform the way the NHS is run in England.

Aspects of the Bill, such as the greater involvement of clinicians in planning and shaping NHS services, have the potential (if implemented well) to improve patient care.  However, benefits that clinician-led commissioning can bring are threatened by other parts of the Bill, particularly:

•            Enforced competition: Forcing commissioners to tender contracts to any willing provider – including commercial organisations – could destabilise local health economies and fragment care for patients.  I believe that the doctors who are responsible for commissioning should be free to work with hospital and community care colleagues and patients to develop the care pathways that, in their clinical judgment, provide the best care for their patients, without fear of a challenge from the new NHS economic regulator, Monitor.

•            Price competition: The Bill will allow providers and commissioners to agree prices below the tariff set by Monitor (to be paid for different sorts of treatments), opening the door to price competition. I am concerned that such a move could allow some providers to chase the most profitable contracts, possibly using their size to undercut on price, which could ultimately damage local services. Price competition has been shown to lead to a reduction in care quality.

•            Pace and scale of change: At a time of huge financial pressure, these major, untested reforms are, undoubtedly, a massive gamble. The deadline for all trusts to achieve foundation status, for example, is 2014. There is a real risk that forcing all hospitals to become foundation trusts before they are ready could lead to a focus on achieving financial stability rather than maintaining high quality patient care.

The Bill is enormous and will have significant impact on the future of NHS services, its workforce, and public health.  I would be grateful if you could ask your colleagues on the Public Bill Committee for the Health and Social Care Bill to raise these concerns and do what they can to highlight and amend the most damaging aspects of this legislation. I would also be happy to meet with you to discuss these issues if you would find this helpful.

All of the above is from a template letter drafted by the BMA junior doctors committee, with which I agree wholeheartedly.  I would also like to add three more concerns –

1. The lack of evidence that the proposed changes will prove of any benefit.  As I’m sure you are aware, we are trained to assess evidence at medical school and during our postgraduate education.  An extremely important part of this training is avoiding cherrypicking of statistics that suit our own views, rather than using the available data to form our opinions.  Cherrypicking appears to be exactly what Andrew Lansley is doing, as demonstrated by Ben Goldacre (http://j.mp/gHq7k2 and http://www.badscience.net/2011/02/why-is-evidence-so-hard-for-politicians/ ).  I believe these two links provide ample evidence to attack Mr Lansley in open debate, as not enough people seem to be aware of the actual data.

2. The white paper does not mention postgraduate training.  Currently, primary care and NHS trusts receive financial incentives from postgraduate deaneries to train junior doctors to consultant level.  During this training, junior doctors ‘rotate’ between the different hospitals within one particular deanery, only reaching consultant level once they have achieved all of the competencies required according to curricula created by the Royal College of each specialty.  Our time is split between service provision (i.e. daily duties such as ward rounds, clerking new patients, practical procedures) and education (e.g. lectures, courses, etc) both of which are necessary to form a ‘complete’ doctor. The current system is uniquely well placed to do this, since hospitals offer a broad range of services, to which we are exposed as juniors.  As consultants, we will be expected to provide appropriate care in all kinds of situations.  Without having experienced a wide range of cases as juniors, we will essentially be handicapped as consultants.

The impending fragmentation of the NHS really worries me for this reason.  The fact that the white paper and the subsequent Health and Social Care Bill do not mention training suggests a real lack of foresight into this.  ‘Any willing provider’ may have no incentive to train, insufficient expertise in training and – most likely of all – a poor range of cases through which juniors can gain experience.

3. In a system where services are provided by ‘any willing provider,’ each provider must devote as much to time demonstrating its superiority over other providers in terms of cost and quality of care as it does to actually providing care.  In this system of continual competition between providers, there will necessarily be fluidity in terms of the flourishing or floundering of each company, consortium or trust.  There will be occasions when these organisations come into financial difficulty, or even go into liquidation.  In such a system, it is unavoidable.  This unpredictability in our healthcare system throws up myriad obvious problems, both in terms of providing care for real people in real time, as well as for planning future healthcare and budgets.  Related to the previous point, workforce planning and training for nurses, doctors, physiotherapists, dieticians, occuaptional therapists, pharmacists and all of the other professional and non-professional workers within healthcare will be impossible.

I write to you in the hope that you may be able to throw the weight of these arguments into the debate for the third reading of the health and social care bill.  If there is any other way that you may be able to oppose it, I urge you to do so.  If you believe there is any other way you think my peers and I may be able to oppose it, please let me know.

Thank you for reading this email, and I repeat that I would be more than happy to meet with you to discuss my views.

Yours sincerely,

Dr _____


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