22 November 2015

"Open " Consultation: Setting the mandate to NHS England for 2016 to 2017

Although you wouldn't know it, the UK's Department of Health has been running a consultation on NHS England.  It has kept this quiet in the hope that no one would reply, and it could just do what it wanted.  

You can read its consultation document pretty quickly, but it probably won't do much good: it's written in the finest officialese that manages to sound impressive, but say very little.  You can respond online, and here's what I've sent them:

Do you agree with our aims for the mandate to NHS England?

Although the mandate is largely fine, it suffers from an excess of generalities. What it lacks is any concrete statement of about how things should be done. I think it is vital that the NHS should be committed to providing a world-class health service using public resources, not private ones. The reasons are simple.

First, the US health system shows us that private healthcare is incredibly expensive, incredibly inefficient, and fails to deliver good healthcare. Moving in that direction would be foolish at best, and downright negligent at worst, since people will die as a direct consequence of doing so.

Moreover, privatising healthcare is foolish for economic reasons: private providers by definition must make a profit, and so by definition are more expensive than publicly-provided resources. Invoking "competition" as a reason why private health provision is better makes no sense, since that competition leads to cost-cutting, which again leads to patients suffering, as recent experiences have shown here in the UK.

Finally, privatisation makes no sense because there is no ownership of skills and knowledge. This would make the NHS a hollow, precarious structure.

Is there anything else we should be considering in producing the mandate to NHE England?

Yes: it should specify as a matter of principle that services will provided publicly, not through private provision. The use of private contractors by public bodies is fine, but the control of every key aspect must remain in public, not private hands, otherwise the profit principle takes over, and people will suffer.

What views do you have on our overarching objective of improving outcomes and reducing health inequalities, including by using new measures of comparative quality for local CCG populations to complement the national outcomes fin the NHS Outcomes Framework?

Fine words again, but without adequate resources, essentially worthless. Unless the NHS is funded adequately, as a matter of priority, it will be impossible to achieve those fine objectives. This will lead to the NHS being dubbed a "failure", which a cynic might suspect is the intention so that privatisation can be offered as the "solution." It is not.

What views do you have on our priorities for the health and care system?

The key priority should be providing world-class healthcare to everyone in the UK free of charge. That is the sign of a civilised country, and failing to do so is to fail that test too. Of course, that requires more resources, in which case it becomes a matter of priorities. But far more lives will be lost as a result of underfunding the NHS than will be lost through terrorism, however much the government likes to exaggerate the threat of the latter. Indeed, the greatest threat to this country is not ISIS/Daesh but things like the end of antibiotics, which could see all major surgery becoming impossible in just a few years. The government should be spending its billions on researching new ways of killing bacteria, not beefing up its surveillance apparatus.

What views do you have on how we set objectives for NHS England to reflect their contribution to achieving our priorities?

Despite all the claims of openness, this consultation has been conducted in near-secrecy. If the government really cared about what the public thinks on this matter (and I do realise that it does not), it would have made far greater efforts to publicise the existence of this consultation. Given the government is now trying to emasculate FOI requests, this is hardly a surprise, but I find the emphasis on openness here a little galling, to say the least.

Do you have any other comments?

I think I have probably said enough...