EastLondonLines reported live on the changes taking place in the NHS as the House of Lords and MPs debated the Health and Social Care Bill on March 13.
The controversial bill is currently at the report stage in the House of Lords. MPs also debated a Labour motion saying the bill should be dropped on Tuesday.
EastLondonLines covered the debates, looking at the impact of the bill on the NHS in East London and asking key figures for their views.
EastLondonLines’ Jo Abbas reports on recent events in East London:
Last week EastLondonLines reported that East London GPs have attacked Prime Minister David Cameron over his claims that doctors in the newly formed Clinical Commissioning Groups (CCGs) support the bill.
CCGs are groups of doctors that will replace Primary Care Trusts. They will be responsible for commissioning or buying local health services, alongside greater competition from the private sector, from April 2013. GPs in Lewisham, Tower Hamlets, Hackney and Croydon are all part of commissioning groups.
The BBC has created a table showing the stance of various health bodies across the UK on the bill. While a report by the Guardian on CCGs, based on data obtained by the campaign group False Economy, said GPs are spending too much time setting them up and too little time seeing patients.
This table shows the data relating to Lewisham and Croydon. Data for Hackney and Tower Hamlets is not available.
False Economy have used the Freedom of Information Act to work out how much the preparation has cost so far and how many doctors are involved. Primary Care Trusts will pick up the bill. The full dataset can be viewed here.
Sophie Mahon and Tom Chlebik on the wider political context:
The Independent and other sources reported this morning that: “Doctors’ leaders have issued an extraordinary appeal to David Cameron for a truce in their vitriolic battle over the Government’s health reforms.”
They report that the chair of the Royal College of GPs, Clare Gerada, has written a letter to the Prime Minister saying the Royal College, while it still opposes the bill, would be willing to work with the Government to implement it.
The Guardian, which is also covering the debate live, has quoted Gerada as saying: “The Royal College of GPs are still asking for this flawed bill to be withdrawn. We think this bill will cause irreversible damage to the NHS. But nevertheless, come what may, we’re doctors and whatever happens, we have to work with the government and the Department of Health to make whatever happens work.”
Gerada has also written to the Deputy Prime Minister Nick Clegg and the Health Secretary Andrew Lansley, who has defended the reforms, saying the changes will stop the health service from collapsing in the future.
In an article in the British Journal of Nursing strongly defending the bill, Lansley wrote: “We cannot afford not to reform the NHS. To take the approach advocated by Labour of simply sitting on our hands would be storing up a crisis for the future.” He said critics of the bill have “distorted” it.
Meanwhile Ed Milliband urged MPs of all parties to state their opposition to the bill during the Commons debate, which will began at 4.30 pm today.
Information on the NHS in East London, by Alice Yehia
The NHS in England and Wales employs around 1.3 million people, approximately one in 23 of the working population.
Each month, 23 million people (more than three times the population of London) visit their GP surgery or practice nurse.
According to NHS figures, 233.226 people registered with a GP in Hackney and City from 2006 to 2011. Figures for Croydon, Lewisham and Tower Hamlets were 340.588, 265.419 and 236.531 respectively.
NHS statistics show the average income before tax for contractor GPs in the UK in 2009/10, by contract type was:
£100,400 for GPs working under a General Medical Services (GMS) contract (compared to £99,200 in 2008/09, an increase of 1.2%).
£115,300 for GPs working under a Primary Medical Services (PMS) contract (compared to £116,300 in 2008/09).
£105,700 for GPs working under either a GMS or PMS (GPMS) contract (compared to £105,300 in 2008/09).
According to NHS data, the total number of all written complaints reported (HCHS & FHS combined) in 2010-11 was 148,200, a decrease of 3,700 (2.4 per cent) from 2009-10.
By subject, the highest percentage of written complaints concerned the subject area “All aspects of clinical treatment” at 44.1 per cent.
In East London, 425 written complaints were made about Croydon PCT in 2009/10 (2010/11 figures are not available), compared to 105 for Tower Hamlets, 33 for Lewisham and 39 for Hackney and City Teaching PCT in 2010/2011.
Barts and the London NHS Trust, covering Tower Hamlets, recieved 1,104 complaints in 2010/11, compared to 318 for East London NHS Foundation Trust, 459 for Lewisham Healthcare NHS Trust and 527 for Croydon Health Services NHS Trust.
The Lords have been discussing regulation of care home workers and other healthcare support workers through either a voluntary or a mandatory register.
Labour Lord Turnberg has said “all too often” there is not enough regulation of support workers. Labour Lord MacKenzie of Culkein argues: “Voluntary registration does not work,” saying there should be a mandatory register and statutory regulation.
The Guardian reports that the Government has announced a pay freeze for all NHS workers earning over £21,000 a month.
The Press Association, via the Guardian, wrote: “NHS workers earning less than £21,000 a year will receive a £250 rise next month, but the rest will have their pay frozen for a second year, the Government said today.
“Health Secretary Andrew Lansley said he had accepted recommendations from the NHS pay review body, stressing the need for restraint in the current economic climate. But unions attacked the announcement, saying health workers now face a second year without a pay rise, making it a ‘struggle’ for them to make ends meet.”
Some background on the bill, by Joanna Kinderberg:
The Health and Social Care Bill was introduced in the House of Commons in January 2011.
Its main purpose is to create an independent NHS board, promote patient choice and reduce NHS administration costs.
The proposed reforms will aim to cut NHS administration costs by a third, and will abolish NHS primary care trusts (PCTs) and Strategic Health Authorites (SHAs).
PCT’s oversee and provide funding for GPs and medial prescriptions, and commission hospital and mental health services within NHS and the private sectors.
At the moment PCTs are responsible for around 80% of the NHS budget. SHAs hold the overall budget and priority responsibility for PCT’s.
The bill proposes increased powers to GP’s to commission services on behalf of their patients. If the reforms become law an independent NHS board would allocate resources and provide commissioning guidance.
Monitor, the body that currently regulates NHS foundation trusts, will become an economic regulator that will oversee aspects of access and competition within the NHS. Local councils will supervise the public health aspects of PCTs’ work.
A graphic produced by Channel 4 also shows the impact of the changes.
The Lords have been debating different approaches to the regulation of social workers.
Sophie Mahon reports on other reactions to the bill:
The Trades Union Congress (TUC), the umbrella organization for Britain’s trade unions, is campaigning to “Save Our NHS.” The TUC’s Going to Work project has posted a series of articles on their blog strongly opposing the reforms.
Their website states: “We aim to unite people who want to see greater fairness and more common sense in the way we work for our economy, and the ways our economy works for us.” They have described the bill as “too drastic and too dangerous.”
The TUC has been trying to change as many minds as possible before the votes in the Commons today and in the Lords on March 19. They are urging people to lobby MPs, and members of the House of Lords through their “adopt a Peer” system.
On the Going to Work blog readers can enter their postcode to find their local MP, and view their voting record on the bill so far.
The Labour Party is also campaigning to stop the bill. Labour leader Ed Milliband said: “Labour is giving MPs from all sides a chance to reflect on what the public is telling them: the Health and Social Care Bill will damage the NHS.
I would appeal to MPs from all parties to stand back, recognise these concerns and take this final opportunity in the House of Commons to reject this Bill.”
Shadow health secretary Andy Burnham said: “”The Government must hear the voices of [the] 170,000 people who have signed the Downing Street petition to express their worries about the damage being done to the NHS.”
At the Liberal Democrat conference last weekend a threatened vote on “killing” the bill was avoided.
However, Dr Eoin Clarke of the Green Benches health blog says today that 5 Liberal Democrat MPs have proposed a motion to drop the bill, saying they decline to support it in its current form.
The Guardian has more analysis of this. “[There] is no chance of Labour and the Lib Dem rebels winning when the vote takes place,” writes Andrew Sparrow.
One of the Lib Dem rebels, Greg Mulholland, is quoted as saying: “Pushing a bill through in any area, never mind in one so important as the NHS, with so many professional organisations and medical professionals opposed is not a sensible or acceptable way to make policy and it is time to get people round the table and find a different and acceptable way forward.”
EastLondonLines’ reporter Miles Fleming interviewed locals in New Cross on their thoughts on the bill:
Graham Chapman, retired, from Richmond upon Thames, said: “I believe the aim is to improve the efficiency of the NHS without massive extra spending. Anything that puts more control in the hands of the family doctor instead of the beurocrats is welcome.”
However local authority worker Neil Langley, 50, from Plumstead, said the increased burden of service management on GPs was “an accident waiting to happen.” “I think it’s absolutely negative,” he said. “I think it’s giving GPs responsibilities that they’re not familiar with, so they are going to have to commission people in to do it on their behalf. So it’s really just making the provision of services for vulnerable people, both young and old, very desperate.
“It’s going to be managed by lots of different pockets of GPs and GP practices, some of whom will be good, some of whom wont. They are all going to be managing it in different ways, Where there is a cohesion now in local authorities’ service provision, that’s going to disappear.”
Student Malcolm Fernandes, 26, from Lewisham, said: “GP’s are going to spend less time with their patients and more time managing. [They] are not trained in that… it’s a bit ridiculous to move the control that way and it’s also moving towards a broader privatization of the NHS – they are going to outsource certain things.”
He said: “There is already mass rejection of this thing, mass protest because of the changes it will make – they should not do it.”
Student Yoel Noorali, 20, from Watford, said: “[It] seems like a step towards privatisation, which I’m not in favour of.”
Social worker Alice, 41, from Sydenham, who declined to give her full name, said: “It is privatization by the back door, and there is no place for competition in health. Doctors, nurses and health workers are significantly opposed, which speaks volumes.”
Lecturer Lucy, from Brixton, said: “Basically it sounds like a smokescreen for privatization, or increased privatization of the health services. I think it’s already affecting the NHS, in terms of a lot of time and energy is going into fighting it within the NHS.
“I think it’s going to lead to a two-tier health service, and unbalanced resources. If I’m ill I don’t want to choose where to go, I just want the best. And I want to rely on a service that will provide the best.”
Diane Abbott, Labour MP for Hackney North and Stoke Newington, told EastLondonLines reporter Chloe Hirst: “The Tory-led Government’s Health and Social Care Bill is unnecessary, unwanted, wasteful and damaging – and threatens to end the NHS as we know it.
“The Bill turns the NHS into a full-blown commercial market, putting competition before patient care,” she said. “They have no mandate for it. David Cameron promised no ‘top-down reorganisation’, the ‘Coalition Agreement’ ruled it out and no-one voted for it.
“Over 170,000 thousand people have already called on the Government to stop. But they are ploughing on, ignoring public and professional opinion, out of touch with Britain.”
While Croydon Labour Councillor Pat Clouder said: “In principle I oppose the NHS reforms. I don’t feel as though they are well thought out.
“We keep proposing questions and they don’t know the answers. I am also concerned how the NHS will monitor the private companies. I am concerned for those in vulnerable positions such as care homes and the elderly.”
The BBC and others report that the Labour and Lib Dem rebel motions to stop the bill both failed, with the Government winning both by over 50 votes.
There will now be a third reading of the bill in the House of Lords on March 19, before it returns to the Commons.