Soubz vs. Dimbleby / Tamar Take-over: Tne NHS.

For no discernible reason, Soubry is due on Question Time in Portsmouth tonight. After the government suffered it’s worse week ever, with the penta-whammy that was GreggsGate, Cameron For Hire, Francis Maude’s petrolheaded idiocy, the worst received budget in memory and the leak tonight that we’re back in recession; this is make or break. A stirling defence, and she can tart eyeing up a front bench position. A flop, and she’ll be seen as the sacrificial lamb offered to the Dimblegod.

I’ll be on twitter  (@Beeestonia, note the three ‘e’s) giving live commentary and examine any claims she makes, but for now I want to publish a great letter I was recently CC’ed into, with Soubry the main recipient. It’s a long one, but a wonderful demolition of our beloved MP’s stance on the NHS. Better stick in a disclaimer: Tamar, the author, is my designer/ columnist /all -round publishing wizard on The Beestonian. Which has it’s latest Issue, number 7, out tomorrow, and it’s a visual feast: we’ve gone and done it in colour to mark the arrival of spring. Or the fact our printer pressed the wrong button. One of the two. Anyhow, over to Tamar:

Dear Ms Soubry,

I have read your open letter in response to the ‘Keep our NHS Public’ postcard petition.  Unfortunately, it has done nothing to allay my fears about the Health and Social Care Bill.  Many of the points you make sit uncomfortably, they read as vague dismissals of your constituents’ genuine concerns about, and disagreement with, the Health and Social Care Bill.

I would never have guessed you would simply argue that all opponents to the Bill haven’t read it / have read but don’t understand it, or are simply, deliberately misleading everyone else in order to… what? I’m not sure. However, it appears as though that’s exactly what you have done.

I would like to address the points you make that concern me most, and respond to them individually.  I have quoted statements from your open letter to me and other constituents (emboldened in green) and follow with paragraphs of my response to your statement. I do so in the realistic acknowledgment that you may only have the time to read a small section at a time before interruption.  Also, I don’t normally ‘do’ this sort of thing, so it’s easier for me too…

________

“There are no plans to privatise the NHS or any part of it.”

The NHS will be treated like a private industry because the Bill will subject the whole NHS to the EU requirement to enforce Competition Law. It will also leave NHS hospitals vulnerable to private take-over because they will have to become Foundation Trusts. Foundation Trusts are autonomous, so will have to fund themselves through bank loans etc. and only have to generate 1p more NHS income than private income.  Therefore, that’s hardly ‘not private’, is it?
Furthermore, many of the executives of the bodies assigned to oversee the NHS have experience in privatising public business, some even receive six figure salaries from current NHS outsourcedservice providers.  There are already areas within the NHS that are tendered out to private companies – public relations companies for example – in areas that were formally provided by public sector staff. Not to mention the sheer amount of lobbying done by US healthcare corporations who know they stand to benefit from the Bill becoming law.

In 2011, you gave assurances to a group of Physiotherapists who came to discuss the Bill with you that the NHS would continue to be “funded by the tax payer”. I’d feel somewhat misinformed by that assurance, were I them.

________

“The very first clause of the Bill sets in law a responsibility on the Secretary of State for Health that he or she must continue to promote “a comprehensive health service{…}” which must be “free of charge.  Either the people who are running the campaign against the reforms haven’t read the Bill of they have and are deliberately misleading people, like you, who care so strongly about the NHS.”

This was already set in Law. Despite the many amendments to the wording, the Bill removes the duty of the Secretary of State to provide or secure the provision of health services in relation to providing free healthcare in that he/she is no longer responsible for providing said healthcare but only responsible for securing their provision through specified bodies. If any of us is unhappy with aspects of decisions made by these specified bodies, we will no longer be able to complain to our MP or Health Secretary because these bodies are autonomous. You know this. Why then, do you seek to mislead your constituents?
Quite why this clause needs to change from the 2006 version has not been explained, yet it is obviously extremely important else it would not have attracted so many wording changes since the Bill’s conception.  Could it be that, if this first clause was removed the EU Competition Law implications could mean the large fines for the Government, I wonder…?

________

“We have increased the amount of money going in to the NHS budget – even whilst we are having to make cuts elsewhere. […] by 2015 there will be an extra £12 billion going in to the NHS.”

I simply draw your attention to John Healey’s challenge of Mr. Lansley regarding this, “The OBR’s [Office for Budget Responsibility] inflation figures mean that the NHS will not get the 0.4% real increase that he bragged about and that was stated in the spending review; the NHS will get a 0.25% decrease – a cut – in funding, as has been confirmed today for me by the House of Commons Library.”

The House of Commons Library figures also show that, when taking into consideration the  social care funding to the NHS, real term change from the previous year is DOWN 0.64% in 2011/12, and DOWN 0.02% 2012/13; 2013/14 is spot-on the same.

You fail to take into consideration, or mention, that the cost of reform brought about by the Bill could be as much as £3 billion; the demands on the NHS to make £20 billion cuts or that inflation will effectively cut the spending power of the NHS. GPs right now are costing £1 million a year in Locum costs as they spend up to 4 days a week tied-up setting up Clinical Commissioning Groups (http://www.guardian.co.uk/society/2012/mar/12/nhs-reform-gps-too-busy) , and someone has to do their day job – part time or not.

Again, back in 2011 you claimed the amount the Coalition was ‘giving’ to the NHS was being increased by “£11.5 million over the next four years” (www.stapleford-notts.co.uk/anna_soubry­_mp__broxtowe-2.htm) which is it? Considering the opening ceremony of the 2012 Olympics alone is going to cost £40 million – so this figure seems like crumbs.

________

“I believe GP’s and nurses in Broxtowe will make better decisions about the needs of patients in our area than administrators based in the north of the County, or in Whitehall.”

If so, why do you not listen to them when they withdraw their support for the Bill, or make statements saying that it “will damage the NHS” (Royal College of Surgeons)? Why do you dismiss the representatives as being “part-time” or say that the vote is not relevant because of the numbers that took part?  The results (released today) of the survey of its membership carried out by the Royal College of Physicians found that more than 6,000 (69% of those who responded) of its members called to reject the Bill, and nearly 5000 (49% of those who responded) called to withdraw from the Bill entirely (you may well argue that the response was low for this survey, but I would point out that it was the highest turnout of any survey of the Royal colleges, and a higher percentage than voted for a Conservative government). It goes on to detail quite clearly their main concerns (http://www.rcplondon.ac.uk/press-releases/results-rcp-health-and-social-care-bill-survey). Other societies held a vote of their fellows in their General Meetings, some of which contained hundreds of the country’s leading experts in their professional field.  Yet you chose to suggest that they too must have not read the Bill/ not understood it or are seeking to deliberately mislead their colleagues and the population as a whole. Despite having a great deal to gain by the passing of the Bill, the Royal College of Surgeons has withdrawn its support of the Bill. It seems to me that it is the Government who is actively seeking to mislead others. The greatest example being that we have had no referendum on this.
We asked you to please listen to the clinicians – to listen to the British Medical Association, Royal College of General Practitioners, Royal College of Nursing, Royal College of Midwives, UK Faculty of Public Health, Royal College of Radiologists, Chartered Society of Physiotherapy, Royal College of Pediatrics and Child Health, British Geriatrics Society, Community Practioners and Health Visitors Association, Royal College of Physicians, Royal College of Physicians of Edinburgh, Royal College of Psychiatrists, Institute of Healthcare Management, Royal College of Gynaecologists, The Allied Health Professions Federation (on behalf of The College of Paramedics, The Society and College of Radiographers, The British Association/College of Occupational Therapists, The British Dietetic Association, The Society of Chiropodists and Podiatrists, The Royal College of Speech and Language Therapists, The Chartered Society of Physiotherapy, The British and Irish Orthoptic Society, The British Association of Prosthetics and Orthotics, The British Association of Dramatherapists ,The British Association of Art Therapists, British Association for Music Therapy) British Psychological Society and the Royal College of Surgeons – who do not/are unable to support the bill, have withdrawn support of the Bill or believe the Bill “will damage the NHS” – or  nearly a million people who have petitioned the government (‘Drop the Bill’ e-Petition = more than 175,000, and 38 Degrees more than  541,902 people).  But you have ignored us, and them, and went along with it anyway.

______

“But unfortunately Labour skewed the financial side of things so that the private sector received more money (about 11%) for the same treatments provided by the NHS. The Health Bill stops this from happening; now the NHS, charities, not for profit organisations and other private organisations will operate on the same footing.”

But you will make it up to around 14%?! You know that this is in part to make up for their exposure to Corporation Tax, and more favourable public sector pension provisions.  Why do you “skew the financial side of things”?  Professor Allyson Pollock goes into detail on this, “Despite the claim of a “level playing field” for the mixed public-private competitive market, in fact it will be operated at a 14% advantage in favour of the private sector. This calculation is reported in the Combined Impact Assessments of the reform, last issued at the end of 2011, and was carried out by KPMG, which is among the private organisations expected to gain most from the passage of the Bill. It awards compensation to the private sector for their exposure to corporation tax and VAT-exempt supply status and for more generous public sector pensions. It also penalises the public sector for the “advantage” of access to “cheap” funding through PFI. None of the cost advantages to the private sector are included in this calculation.”  (Statement in response to the Lib Dem “40 points” document by Professor Allyson Pollock, David Price and Peter Roderick – 9th March 2012)

________

“GP’s will continue to be able to get health treatments from both the NHS and the private sector – which includes charities and not for profit organisations. But they will not be able to choose the cheapest treatment – instead, the criteria will mean they will need to choose the best treatment. And your GP will be able to offer you a choice of where to go to get the best health care you need. So when the opponents of the Bill talk about “competition” what they fail to explain is that a charitable organisation offering a treatment for, say, older patients will “compete” with the NHS offering a similar service on the basis of which one is the best for the patient, not which one is the cheapest.” 

You fail to mention, however, that Under EU procurement law one of two procedures must be used whenever public sector procurement is carried out through competitive tendering. One of which is based on cost, and the other (the “Most Economically Advantageous Tender”) combines cost and quality.  So your statement that procurement in the NHS will ‘not be on which is cheapest’ is misleading.

________

“The other important part of the Bill places a statutory duty on everyone involved in the NHS to reduce what are called “health inequalities”, a problem that got worst under the last government.”

The BMA doesn’t agree with you. They say, “If passed the Bill will be irreversibly damaging to the NHS as a public service, converting it into a competitive marketplace that will widen health inequalities and be detrimental to patient care”.  The Allied Health Professions Federation of Health doesn’t agree with you either, “The competitive approach to the delivery of health and social care as proposed by the Health &Social Care Bill could well discourage integrated care pathways leading to fragmentation of services.” And neither does the Royal College of Paediatrics and Child Health, “We believe that the Bill will undermine choice, quality, safety, equity, and integration of care for children and their families. The NHS outperforms most other health systems internationally and is highly efficient. The 2010 Commonwealth Fund report on seven nations ranks the UK second overall and best in terms of efficiency and effective health care.”  It goes on to say that competition-based systems are less efficient, and that Children with disabilities or chronic conditions will suffer most, “A family with a disabled child will find it more difficult and complicated to organise a complex package of care, because integrated working between the NHS and local authorities will become much harder to achieve.” (http://press.thelancet.com/Paediatricians.pdf)

Anyone with more than one chronic condition will be affected by this lack of efficiency; and it could multiply for each condition, as specialist conditions require specialist care and these will not necessarily be integrated in the way they currently are.

________

“I think people opposed to the Bill have somewhat taken advantage of people’s genuine concerns and heartfelt support for the NHS.”

I think that people who oppose the bill share the genuine concerns and heartfelt support for the NHS. I know, because I am one.

People who have led demonstrations, petitions and active campaigns have merely scrutinised the Bill (I too have read it. So have many of my fellow opposers to it) and translated it into a summary more suited to the busy, tax-paying, NHS-using man or woman on the street.  You acknowledge that it is a complex, technical document.  But you also go on to patronise people, your constituents, who have taken the time to read and decipher it for themselves or by calling on greater experts within medicine via the media and the internet.  The difference between the opposers to the Bill and yourself, Ms Soubry is that they have listened to the experts where matters fall beyond their own field of expertise or understanding. You and your colleagues in Government have allowed clinicians and the medical experts’ words to fall on deaf ears; you’ve blocked them out.

You have dismissed the clinicians’ claims to ‘being in the majority against the Bill’ because you consider  the numbers voting or responding to surveys not representative of this.  You  forget, Ms Soubry, that this country did not vote for the Conservative party; we did not vote for a Liberal Democrat/Conservative Coalition government. Furthermore, we did not vote in the General Election with this Bill on the horizon. This top-down reform was not only not part of any Party manifesto; it was not part of the Coalition agreement.  However, Mr. Cameron did state quite clearly, “With the Conservatives there will be no more of the tiresome, meddlesome, top-down re-structures that have dominated the last decade of the NHS” (and the Coalition Agreement reiterated this statement later).  This u-turn would appear to paint Mr. Cameron as either a liar, a manipulator or, in the very least, someone who can’t be trusted not to go back on their word.  His word means nothing. The BMA has said, “…over time, it has become clear that this is the most top-down reorganisation the NHS has seen since its inception… the ability for ordinary GPs to change things will diminish.”

To add insult to injury – and despite all the listening to “arguments for and against” you have been doing, or not doing, “at length” – we have not had a referendum on this.  Redefining the remit of a crucial public service so categorically without consultation of the elective who fund and use it is nothing short of tyrannical.
I whole-heartily believe you should be ashamed of yourself for supporting this Bill, and for failing to represent the interests of your constituents to the Government.

I’m sure it will become very clear, in the days, months and few years after this Bill goes through that, although the present Government may have felt it had a lot to gain by getting this Bill through parliament, ultimately it will lose everything. Because at the next General Election I imagine it will be elected off the premises.

I hope you take the time to consider these points.  I know they will do nothing to change matters. But I want to convey to you very clearly that, as my MP, I hope you will in future refrain from making the assumption that your constituents are merely ‘sheep’ led about by others in forming their opinions. We are not so different to you – we are capable of reading the Bill, and of hearing a person’s words and understanding them.  And, especially in the absence of any clear and accurate information we can trust, we most certainly can, and do, go on to find out the information for ourselves.

Thank you. I do appreciate your time and attention.

Yours sincerely,

Tamar Feast

Beeston,

Nottingham.

Cc. The Beestonian

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6 thoughts on “Soubz vs. Dimbleby / Tamar Take-over: Tne NHS.

  1. Ben Beeston says:

    Brilliant letter. I look forward to Anna’s reply

  2. kerrycooks says:

    I got that letter from her too. Thank you Tamar for having the knowledge and energy to put together an awesome reply!

  3. Michael says:

    No reply yet, I take it? I emailed Anna about two months ago on the NHS Bill. As has been observed on previous posts, once she realises she can’t fob you off with platitudes and unreferenced assertions, you don’t get any more time wasted on you.

    I once got a long reply from Nick Palmer at 3am, telling me why he disagreed with me on tuition fees. Oh, for those days…

    • tamar Feast says:

      I received I reply from Ms Soubry, dated 29th March. It says the following:
      ” thank you for your recent letter about the Health and Social Care Bill.
      You raise a number of varied and detailed points in your letter, which I feel would be better addressed in a face to face meeting at my Constituency Office.
      Please contact my office on 0115 9436507 to arrange an appropriate date with a member of my team.
      Thank you once again for your letter, and I look forward to meeting with you.
      With best wishes
      (signed Anna)”

  4. James D says:

    Convenient way of avoiding going into print methinks Ms Soubry!

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