h1. Reply To Letter About Health Bill From Don Foster MP
p(meta). 15th September 2011
Here’s a reply I received from my MP, Don Foster, to the letter I sent him about the Health and Social Care Bill.
This is a form reply he sent to everyone who contacted him. Needless to say, he voted for the bill again.
Now we must take this to the Lords - there is a chance that some decent amendments will be made there. I urge you to consider donating to the 38 Degrees campaign for lobbying the Lords, and also to Adopt A Lord and write to him/her directly.
Anyway, here is Don Foster’s reply.
Dear Dominic,
Thank you very much for contacting me about the reform of the NHS.
I received comments from over 500 constituents and am grateful to all of them.
I hope that this letter covers all the main points that were raised including the legal opinion that had been given to the organisation 38 Degrees. The length of this response reflects the seriousness and complexity of this issue.
However, based on the substantial changes secured by my Liberal Democrat colleagues and me, on a consideration of a wide variety of advice on the legal opinion, on further assurances given by Health Ministers, and detailed discussions with very many people, I voted FOR the Bill on Wednesday. I hope what follows will help explain why.
But first, I want to make clear my position on “privatisation” of the Health Service.
Some people have talked about the spectre of “privatisation” or “break up” of the NHS into some model resembling health care in the USA or many EU states. I am clear that there was never any intention that this was the purpose (or an unintended consequence) of the Bill. There was never a chance that I and my Lib Dem colleagues would have allowed that to happen; I can emphatically assert that – because of changes insisted upon by Liberal Democrats - there will be no “privatisation” of the NHS and no special concessions (i.e. “cherry picking” or favourable tariffs) to private sector providers of health care. The NHS will remain free at the point of need and treatments will be paid for by our taxes.
It is important to note that this does not mean that there is no role for non state-owned providers of health care. Ever since its inception in 1948, the NHS has commissioned care from private doctors and companies. The vast majority of family doctors in Bath are essentially private professional practices which derive most of their income from the NHS. There always has been, and will continue to be, a mixture of providers of health care. The important point for each patient is that the treatment is paid for by the NHS, no matter from whom it has been commissioned.
Where competition is present it will be in areas such as quality and alternative treatments, not on price for specific treatments as these will come under a set NHS tariff. Furthermore, unlike the previous government, the Coalition is determined that it will not simply promise payment to such organisations regardless of whether or not those organisations have seen NHS patients. The last government encouraged the setting up of Independent Sector Treatment Providers (such as those in Bristol, Shepton Mallet and Devizes) specifically to compete with NHS Trust Hospitals. I do not support this approach and I am delighted that the arrangements will now change so that they don’t undermine, for example, the RUH.
One of my key reasons for supporting the Bill was to “lock in” the very many significant improvements – like the ban on cherry-picking - that I and my Liberal Democrat colleagues in parliament achieved in recent weeks.
As you will be aware many people, including doctors, nurses and patients expressed concern regarding the contents of the initial version of the Health and Social Care Bill during the Liberal Democrat Spring Conference in March. Thanks to the subsequent actions of Nick Clegg and Liberal Democrats within government the progress of the Bill was paused while the concerns expressed were given proper consideration.
The result of this is a vastly improved Bill guaranteeing that the interests of patients are always put first and ensures that there will be no privatisation of the NHS and no special favours to the private sector.
Because these changes have not been well publicised I am listing some of them below. Competition • The core duty of Monitor (the Health over-sight body) will be to protect and promote patients’ interests. • We will remove the originally proposed powers of Monitor to “promote” competition and it will be required instead to support the delivery of integrated services for patients where this would improve quality of care for patients or improve efficiency. • The Bill will not change EU competition law (see below). Safeguards against privatisation • We will create additional safeguards against price competition and “cherry picking”. • So that providers cannot “cherry pick” the profitable, “easy” cases, services will be covered by a system of prices that accurately reflect clinical complexity, except where this is not practical. Commissioners will be required to follow “best value” principles when tendering for non-tariff services, rather than simply choosing the lowest price. • We will outlaw any policy to increase the market share of any particular sector of provider. This will prevent current or future Ministers, the NHS Commissioning Board or Monitor from having a deliberate policy of encouraging the growth of the private sector over existing state providers – or vice versa. The role of the Secretary of State • The policy is that the Secretary of State will be responsible – as now – for promoting a comprehensive health service. The wording of section 1(1) of the 2006 NHS Act will remain unchanged in legislation, as it has since the founding NHS Act of 1946. This will be underpinned by the new duties that the Bill already places on the Secretary of State, around promoting quality improvement and reducing inequalities.(See also below). Clinical commissioning groups • Commissioning consortia will continue to be based on groups of GP practices, but now others will be involved so that commissioning will involve patients, carers and the public and a wide range of doctors, nurses and other health and care professionals. Clinical commissioning groups will have a duty to promote integrated health and social care around the needs of users. • We will make it explicit in the Bill that commissioning groups must commission all urgent and emergency care within their boundaries, and are also responsible for any unregistered patients who live in their area. In other words, they will be responsible for their whole population not just their registered patients. • Clinical commissioning groups will not be required to start until they are ready to do so. • We will amend the Bill to strengthen and emphasise commissioners’ duty to promote choice, in line with the right in the NHS Constitution for patients to make choices about their NHS care and to receive information to support those choices. Governance and accountability for commissioning groups • Every commissioning group will have a governing body with decision-making powers, to ensure that decisions about patient services and use of taxpayers’ money are made in an open, transparent and accountable way. It will have to include at least one registered nurse and one doctor who is a secondary care specialist. • To enhance transparency and accountability, governing bodies will be required to meet in public and publish their minutes, and clinical commissioning groups will have to publish details of contracts with health service providers. Health and Wellbeing Boards and local authorities • We will give Health and Wellbeing Boards a new duty to involve users and the public. • The Bill will make clear that HWBs should be involved throughout the process as clinical commissioning groups develop their commissioning plans. • HWBs will have a stronger role in promoting joint commissioning and integrated provision between health, public health and social care. • Local authorities will still be able to challenge any proposals for the substantial reconfiguration of services. My other reason for supporting the Bill was because I was not persuaded by some of the arguments made against its revised form following the concessions gained by the Liberal Democrats.
For example, many constituents were concerned about the role of the Secretary of State for Health.
The original 1947 Act that established the NHS made the Minister for Health responsible for the provision of a comprehensive system of health care. Reforms of the NHS by successive governments have amended that duty, essentially reflecting that fact that government is usually an enabler rather than a direct provider or commissioner of services. Indeed, the current situation is that Secretary of State delegates the commissioning of health care to a network of Primary Care Trusts (B&NES PCT in our case).
But some people argued that the Bill will allow the Secretary of State to “wash his hands” of responsibility for commissioning within the NHS. I can assure you that this is not the case. The Bill retains the legal requirement that services be free of charge (except where already specified) and now includes requirements as to securing continuous improvement in the quality of services provided. It also promotes research and the use of evidence learned from research, and for the first time ever, promotes the need to reduce health inequalities. It would therefore be impossible for the Secretary of State to able to “wash his hands” of the NHS, while he remains legally required to deliver all of the duties outlined above. Crucially, the Secretary of State also retains the duty to promote a comprehensive health service, which dates from the founding NHS Act of 1946. That duty has stood the test of time for 60 years and has been unchanged by this Bill. The Secretary of State will have the duty to secure that services are provided for that comprehensive health service, and will have failed in his duty if they are not.
The Secretary of State also has the obligation to set the goals and priorities for the NHS through the “mandate”, which will set out what the Secretary of State wants the NHS to deliver. It will be updated every year and will be subject to Parliamentary scrutiny – giving Parliament, for the first time, a detailed say in what the NHS is tasked to deliver.
However, I understand that despite all these existing provisions in the Bill there are still concerns regarding the role of the Secretary of State. It is understandable, given that we are talking about the future of our most treasured national institution, that people express such concerns and are not willing to tolerate even a sliver of doubt about the safety of the NHS in the future. That’s why my Liberal Democrat colleague, Health Minister Paul Burstow, announced in Parliament that the Government are willing to listen to the concerns that have been raised and, if necessary, offer clarifications or make amendments to put beyond legal doubt that the Secretary of State remains responsible and accountable for the comprehensive health service we all want to see. So, the Health Secretary will retain ultimate responsibility for the provision of health care.
Some people have also have cited “competition” and “EU regulations” as a concern. The Bill makes no changes. They will be the same as those established by the last Government.
But we are making one change to what happens in a dispute. The government believes that if there are any disputes between organisations - private or public who deal with NHS patients they should not be referred to the Office of Fair Trading (OFT) as though they were ordinary trade disputes. Instead these disputes will be referred to a special health body (Monitor) that is aware of how important and special health services are. This was the recommendation made by the independent Future Forum as the best safeguard against competition being applied disproportionately.
However, I do understand and agree with concerns that businesses should not make unfair levels of profit from health care. As mentioned above, the Coalition government intends that this Bill will place important limitations on the applicability of competition law so that those charities or private firms who do bid to provide treatments should not be allowed to “cherry-pick” or undercut on matters of price.
Throughout the consultation on this Bill, the Liberal Democrats have sought to emphasise the importance of properly integrating local health services and ensuring their sustainability, and enhancing local as well as Parliamentary accountability. As well as confirming existing and introducing new duties for the Health Secretary, the Bill also gives much more scope for decision making and scrutiny in Bath. A new Health and Well Being Board will be set up in B&NES Council will also have new duties in public health. I believe that we will be able to build an NHS that has a strong set of legal duties on the national government, but where local health care professionals and politicians will be able to design and commission health care services that address local needs.
The Liberal Democrats have made valuable changes to the Health and Social Care Bill which I believe will not only secure the future of a comprehensive system of health care but also lead to improved levels of service. The very nature of health care means that we cannot have a template of provision that can never be subject to reform or innovation. Advances in medical research and demographic change mean that we must make sure that our system of health care matches contemporary needs and circumstances.
I greatly value the NHS and I fully understand that many people in Bath regard it as our greatest national institution. The issues discussed in this letter are as important to me as they are to you and I have given them a great deal of thought over many months. No piece of legislation can ever satisfy everyone and no doubt there is a scope for further clarification as the House of Lords now considers the Bill.
Thank you for your interest in the Bill and hope that this reply has gone some way to reassured you.
Yours, Don Foster MP </em>