David Hickson's NHS Patient Blog

My recent bloggingsQuick Links
→   HELP
→   Blog Comments
→   Campaign Summary
→   Problems with tiny.cc links
→   Database of GPs

Tuesday, 13 October 2009

Theft of the NHS

Once we had only "24 hours to save the NHS"

Around 24 hours ago, in its dying days, the present New Labour government, which was first elected on this claim, has used its parliamentary majority to steal the NHS from the people. This has been achieved most subtly under the guise of protecting it.

The NHS is owned by us all. It is not owned by the Crown or its Ministers representing the government in power at any time, nor by those appointed, recruited or contracted to work for the NHS. We are represented by our Parliament in the House of Commons, and we look to this body to protect our NHS. Its power to do so is most effectively exercised through its ability to pass legislation.

Professor (shortly to be "semi-retired Lord") Darzi reported for the government in 2008 that there would be a NHS Constitution, to "Secure the NHS for the future". He stated that "to qualify as a Constitution the document needed to be short and enduring", and "to be meaningful it must have bite, with means for enforcement and redress, not just warm words or aspirations".

In his Foreword to the Darzi Report, Alan Johnson, then Secretary of State for Health, said with reference to the Constitution - "The NHS is as much a social movement as a health service. That is why it is so vital to secure its founding principles and set out the rights and responsibilities of patients, public and staff."

Last night, the Health Bill, with provisions to give legal effect to the NHS Constitution came before the House of Commons for the final stages of deliberation. An amendment was tabled to place the core principles of the NHS within the Bill. This was necessary as there was no other provision to give legal force to the terms of the Constitution, only recognition of its existence.

The proposed amendment was therefore essential to provide a legal safeguard for the principles of the NHS. The so-called Constitution document that has emerged cannot be embedded in legislation as is indeed lengthy, in some parts highly detailed for the current time and openly full of aspirations. By Darzi's own definition it fails to qualify as a Constitution, in any meaningful sense of the word.

The very brief discussion of this amendment (which had previously been considered and rejected in Committee) was not around the wording of the principles. It was opposed outright by the government Minister, who stated "We need to ensure that the NHS is the area where this decision-making takes place, not the courts." [Hansard 12 Oct 2009 - Col 114]

In his subsequent paragraph Mike O'Brien referred to parliament "abrogating responsibility"; however he was, most disturbingly, using this term to describe legislating so as to empower the judiciary, rather than leaving power in the hands of the executive. Parliament's responsibility for the core principles of our NHS must be placed in legislation for the courts to interpret and enforce, not abrogated to those who happen to hold senior positions within the Department of Health and the NHS.

On a division, the New Labour majority in parliament was used to defeat this amendment, and on the subsequent Third Reading of the Bill to confirm responsibility for the principles of the NHS to rest with the management of the NHS itself. This is ultimately officials and Ministers in the Department of Health, although much of the responsibility rests with personnel appointed to local Trusts.

This is highly relevant to the specific issue on which I am campaigning, as the underlying issue is the integrity of the NHS as a publicly owned institution, accountable to the people, not as a set of "consumer-focused" enterprises with a duty only to the customers they can attract in a marketplace.

Use of revenue sharing telephone numbers as a means of subsidising the cost of providing NHS services at the expense of patients is a fundamental breach of the principle of "free at the point of need". If consumers can be persuaded to pay for improved NHS services when exercising "choice", then there could be seen to be no problem. That is NOT the NHS that I seek to defend.

Use of revenue sharing telephone numbers may be only a modest example of "services being jointly funded through patients' contributions" (without parliamentary approval), as it was described by Mike O'Brien in Committee (Hansard: Health Bill [Lords], Public Bill Committee, Second Sitting, 16 June 2009 - Column 53); but my concerns extend to the others that exist now and could arise in future.

A ban on "The use of phone numbers that charge the public or patients a premium rate to contact the NHS" has been announced on the basis that revenue sharing 084 numbers may continue to be used "providing patients are not charged more than a local rate number". There is and can be no situation in which this could be assured.

Telephone tariffs cannot be set by ""changes to the GP contract (in consultation with the British Medical Association's GP Committee), and the issuing of Directions to NHS PCTs and Trusts". This is precisely what is suggested in the announcement.

A ban on the use of revenue sharing telephone numbers by all NHS providers is necessary to protect the principle of "free at the point of need". This ill-considered ineffective attempt has disregarded wise and helpful advice presented in a consultation in favour of partial and false representations by interested parties. It is not only thereby a bad decision, but it also represents licence for continuing breaches of the principles of the NHS. This is exactly how it has been interpreted by the parties whose interests would have been threatened by a ban. (see NHS FREE TO CHOOSE 084 NUMBERS FOR LOCAL PATIENTS)

This example demonstrates what can happen when application of the principles of the NHS is left solely in the hands of those with Political and other interests, without protection from Parliament through legislation.

It is simply not safe to leave our NHS in the hands of a Minister who defines its principles in the following terms (Hansard: Health Bill [Lords], Public Bill Committee, First Sitting, 16 June 2009 - Column 12):
"The core principle of the NHS—that it is funded by the taxpayer to ensure that the provision of healthcare is available when it is needed, sometimes with a charge, but more often without - must remain intact. We have not announced anything that would undermine that principle."

I repeat: "
the core principle of the NHS -
sometimes with a charge, but more often without

" - had I not heard this nonsense in person, I would have doubted the Hansard writers.

This unworthy rubbish is completely unacceptable for our beloved NHS - and the NHS is now denied legal protection against it. It is intolerable for parliament to have abrogated its responsibility by placing the principles of the NHS in the care of such people.


  1. Don't forget, of course, that dental care is charged for. So maybe the maxim should be "free at the point of delivery, except when the Government wants to charge for it."

  2. Dental care, along with prescriptions and eye tests, is subject to charges levied by the NHS. These are however on a defined fixed scale and are subject to exemptions and limits which broadly reflect need and ability to pay.

    Charges for NHS services set by providers, in the belief that they are acceptable in a market based on the quality of care provided, are a totally different concept. This is fundamentally incompatible with the principles of the NHS.

    We already have that market. We must recognise that adding a financial element for patients would be very different from the existing NHS charges (and charges for non-NHS services such as car parking). If we cannot recognise the difference then the principles of the NHS are lost.

    The suggested maxim is almost correct - the first right in the NHS Constitution does permit charges sanctioned by "parliament". Where a Government commands a parliamentary majority, that simply means "the government, subject to debate". If we were to have a more truly representative parliament, then the distinction would be clearer.


See help

Search This Blog