The Independent View: You should be worried about the NHS changes

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I am a consultant paediatrician* (I am writing under a pseudonym to protect family, colleagues and patients) with over 20 years experience. I work with parents, many of whom have problems with mental health, substance misuse or learning difficulties. My job is to help protect their children and prevent them from following a similar life path.

I know what the effects of the Health and Social Care Bill will be because I can see it happening already. Looking after vulnerable children who are at risk of harm is becoming much more difficult because of the needless reconfiguration of services, whilst simultaneously attempting to make unprecedented savings.  We must stop this Bill now or risk catastrophic breakdown of services for the most vulnerable children in society.

Let me illustrate the issues I face.  It is a Saturday afternoon earlier this month, I am on call, and I have just spoken to the emergency duty social worker who explains that NSPCC received a call from a nursery worker who was extremely concerned about sisters aged four and six. The younger one confided that her father is sexually abusing her. Initial enquiries reveal a family history of abuse. The father has a criminal record for violent sexual offences and drug dealing.  On week days I would be able to telephone the child’s GP for help with this family. But out of hours care is now provided by a Consortium of GPs and they cannot access primary care records.  Not helpful for these children right now.

There is no doubt in my mind that these girls are at risk of harm. They need protection. It’s urgent. Normally the Police are excellent, but today there is no Child Abuse Investigation Team (CAIT) available locally, so there is no person from the police with the skills to interview young children about suspected sexual offences. Contracts are being renegotiated and cross-cover arrangements for weekends have yet to be finalised.

The duty social worker cannot access previous social care electronic case files because the IT contract is with a private provider who does not provide technical support during weekends. So no further information is available.

The child protection system is only as good as its weakest link. On balance the best option was to wait till Monday when normal service will be restored. But I worry about these children over the weekend.

 Are you worried yet?

I don’t think this Bill will improve child protection services and the vast majority of my colleagues agree.  Since free market competition-based health care systems are more expensive, less efficient and associated with gross inequities, this doesn’t feel like good clinical practice, nor safe and effective care for maltreated children.

The Health and Social Care Bill will increase bureaucracy because the number of statutory organisations will increase from 163 to 521. These are supposed to be co-ordinated through Health and Well-Being Boards (HWBB), but without all the child safeguarding organisations present on these Boards, it sounds like a formula for “not in my budget”.

Children have the right to grow up in a society where they are valued, where high-quality services are easily accessible, where the best interests of children come before commercial and political interests. Fragmentation of services has already started and will only get worse Children deserve better than this Bill. I am worried that more children will be abused and die. You should be too.

The Health and Social Care Bill signals the downfall of the NHS as the most equitable health service in the world. It will lose Liberal Democrats both credibility and votes.

Do not let this Bill pass. Only you can protect the NHS now.

“Dr Thomas Jones” is a pseudonym. The author is a  Consultant Paediatrician and Designated Doctor for Safeguarding Children and has asked for professional reasons to publish this article under a pseudonym. Their identity has, however, been verified by the site’s editorial team.

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29 Comments

  • Unfortunately to me this article reads like more of a critique of modern life/computers/any form of change than of the coalition’s NHS bill. Most of your problems seemed to revolve around the inability of one area to access computer records due to their poor knowledge of new systems or insufficient permissions caused by people not being in at the weekend.

  • Most of these complaints are about things that already exist in the NHS, that were already permissible long before the Coalition came into being, the outsourcing of out-of-hours care for example. The Bill doesn’t get rid of this ability to fragment but it won’t increase it considerably either. It will, however, allow for far greater scrutiny of how services are designed. It’s a bit ridiculous referring to health and well being boards as ‘bureaucracy’ when they are the way the decisions of clinicians will be scrutinised effectively. The whole problem with the PCT bureaucracy was that there was so little scrutiny.

    This Bill really is going to be the test of whether localism can work or not. If people want to avoid the bad outcomes highlighted in this article, they will have to engage in local democratic activity to do so. In fact, even if the Bill is dropped completely, which would leave far too many unanswered questions about NHS structure, we as a party still need to focus on sorting out health services at a local level, something we’ve blithely ignored for too long.

  • I prefer to believe the expert writing this article, who is telling us that marketisation and privatisation bring fragmentation and potential dangers for vulnerable children.

  • local gvt worker 7th Mar '12 - 3:37pm

    Seems to me these problems stem from a lack of co-ordinated out of hours service for children at risk. Surely this should be led by the local authority, through the corporate parenting board and social services? In which case, I fail to see how moving from a currently fragmented structure between local gvt, nhs and police, to a more co-ordinated approach through HWBs and the incorporation of public health into local authorities is going to hurt.

    I am sure the author is genuinely concerned about this, and don’t doubt the chaotic nature of things right at the moment, where most of the nhs structures are in limbo, but I do think this piece doesn’t reflect the way that local authorities are going to be involved through HWBs. If this situation were to occur in the post-Bill NHS it would immediately be taken up by the HWB and a resolution be worked towards.

  • Implying that it is the fault of the Lib Dems if children are abused is beneath even the No2AV campaign. I’m not surprised the author chooses to hide their real name.

  • Grammar Police 7th Mar '12 - 3:47pm

    “Since free market competition-based health care systems are more expensive, less efficient and associated with gross inequities”

    Which is a fantastic reason to object to the Bill, if it was actually going to bring in a “free market competition-based health care system”.

    The public outcry over this Bill has depressed me thoroughly about the standard of public debate in the country. There are bad things in this Bill; there are good bits too. In that respect it’s much like any other Bill. And yet the debate has stayed broadly within the realms of the current NHS-as-a-religion, and woe-betide anyone who questions the faith, even round the edges.

  • Andrew Suffield 7th Mar '12 - 3:57pm

    I prefer to believe the expert writing this article, who is telling us that marketisation and privatisation

    Hang on. He’s an expert in what now? Economics? Evidently not in the content of the bill, since it doesn’t bring in privatisation at all.

    There are some very real problems referenced in this article, and they are problems of a legacy of poorly designed bureaucracies and computer systems where the priority was spending a lot of government money on something shiny.

    It is immediately obvious that this doesn’t have a lot to do with the current bill, in either direction. Which is a pity; I want to see a bill that addresses these issues.

  • Andrew, if you really think that this bill does not bring in increased privatisation, I do not think there is any point in my debating it.

  • ……..”it’s much like any other Bill. ” No it’s not. It was never put to the electorate. We have a democratic tradition in this country; it is normal for a political party to put their plans/ideas/intentions before the British electorate (manifestp). This Bill never saw the light of day before the last election. Lansley had, apparently, been knocking this together for years, the problem is that neither he, nor the Tory party nor the LibDems got round to asking/consulting the electorate. Is it any wonder that voters are not best pleased? For Britain read Russia.

  • @Jonathan Calder
    The BMA are a trade union, and whilst they represent both General and Specialist Medics they are not what I would class as an expert body. There are numerous Colleges / Faculties against this Bill who are experts in their field who should be listened to, for example the RCGP’s.

  • The general gist of this post is all too familiar to the effects of competitive healthcare provision in the United States. A recent article published by a Laboratory Medicine website trumpets opportunities for clinical laboratories to expand and provide profits on the back of the closing of other non-profitable clinical areas (such as mental health). As a biomedical scientist I should be pleased with this but some how I’m not… where does one go for mental health care if the local “not for profit” hospital has closed it’s offering.
    Read the link below to get an idea of what competition in a free health care market really means…
    http://www.darkdaily.com/tough-economic-times-motivate-hospitals-to-migrate-away-from-unprofitable-clinical-service-lines-30712#axzz1oRKkLGgX

  • David Allen 7th Mar '12 - 5:30pm

    “Whatever the rights and wrong of this debate, just saying “leave it to the experts” will not do as a response.”

    No, indeed it won’t, fair comment. However, finding specious reasons to ignore what experts are telling us is even worse.

    Yes, this author does acknowledge a viewpoint that “free market competition-based health care systems are more expensive, less efficient and associated with gross inequities”. I am inclined to share that viewpoint, since it is what evidence e.g. from the US tells us, but, I would admit that it shows that the author has chosen which side he is on.

    However, he also explains quite clearly why fragmentation and increasing bureaucracy will make things worse. So when loyalist apologists go on about it just being a moan about computers, etcetera, they do seem to be wilfully failing to read the article. And as for the commenter who trumped up the pretence that the Lib Dems were virtually conniving in child abuse – Well, it is not the original article writer who evidently belongs on the staff of the News of the World!

    Come on guys, whatever happened to the old Lib Dem principle of robust but honest debate?

  • Richard Dean 7th Mar '12 - 7:11pm

    @Dr Jones,

    Excuse me for being ignorant, but what was your proper role in this Saturday afternoon drama? As I understand “pediatrician”, you are a doctor who specializes in children’s medicine. Was your role to examine the children medically, or to manage the case on behalf of social services?

    If the father has a criminal record of sexual abuse, that information came from a database, and the people who manage that database are likely to have some form of powers, perhaps even of arrest, or at the very least they will have credibility with the police, who are normally nothing like as unhelpful as your paint them, particularly in this kind of case. And just because a GP is part of a consortium does not mean he or she is un-contactable – on the contrary, there will normally be a GP on call, and you can get that GP’s number by calling the health centre answerphone.

    I apologize if this question is rude, but is your story true? Is it perhaps something that you have imagined, something that illustrates your worries, rather than a true event? I’m surprised that a father who has a history of sexual abuse is allowed the free access to his children that your story implies, but I don’t know. I’ve got to say, if the story is true, that it presumably happened under the present system, so not passing the new bill won’t help at all.

  • @Richard Dean
    Sorry but you are incorrect on GP’s. The article states that GP out of hours care is provided by a consortium not that the GP was part of it. I don’t think any of the GP’s at my practice are part of my local out of hours service, they were allowed to outsource this part of their duties some years ago. Therefore it is quite common not to have access to anyone from your surgery, let alone your GP out of hours.

    I think the author is trying to point out that the fracturing of services leads to a breakdown of communication between the various parts of the system. I must admit, as someone who is against the Bill in it’s current format, I did not follow why this particular situation would be made worse by it….

  • Richard Dean 7th Mar '12 - 9:59pm

    @Steve Way. Thanks for your correction. But an out-of-hours service is still a service, and the GPs outsourcing it surely recognize that records are important, particularly in this kind of case? Or perhaps actually they aren’t? GPs are not totally bad people. Whatever may be the laws under which they operate, they still have a right to their weekends away from work. Issues of weekend cover are not really the same as issues about fragmentation.

  • “The duty social worker cannot access previous social care electronic case files because the IT contract is with a private provider who does not provide technical support during weekends. So no further information is available.”

    Why would a private provider automatically not provide technical support over weekends. For example Westlaw have a 24/7 support provision http://www.westlaw.co.uk/support/index.shtm

  • Tony Dawson 7th Mar '12 - 11:18pm

    @Hywel :

    “Why would a private provider automatically not provide technical support over weekends?”

    Just a guess: because the people contracting this part of the service didn’t ‘spec’ the contract to include such a thing, presumably because it is cheaper not to include it?

  • Richard Dean 8th Mar '12 - 12:15am

    @Tony Dawson. Actually, this is a case where commercial concerns might have a very clear beneficial effect. A private provider would be keen to receive income for providing that service, and would have certainly pointed out the omission to the spec. A very aggressive provider might even have mobilized pressure to get the spec changed. Under the proposed bill this would pesumably part of the Secretary of State’s duty to promote a comprehensive service.

  • Julian Tisi 8th Mar '12 - 8:20am

    I agree with Oranjepan – “It accepts a pseudonymous expert citing a single extreme example as an illustration, yet the construction of the argument is to join-the-dots between random data points. It is a collander of logic.”

    I have yet to hear a good reason why we should reject the NHS bill outright, as very well amended by the Lib Dems. I’ve heard lots of self-serving ones and lots more from the “we hate the Tories and the market economy generally” brigade.

  • Rebecca Hanson 8th Mar '12 - 8:53am

    This article is grounded in reality.

    Andrew Tennant’s article defending the reforms smacked of the think tank culture of idealism.
    I refer you to Dr Bronowski:

    As someone who works in education who can clearly see that current policies of free markets in education have been created by a ‘cult mindset’ which has no test in reality or the academic study of the economics of education this juxtaposition makes the situation clear.

  • Matthew Huntbach 8th Mar '12 - 10:11am

    Jonathan Calder

    Whatever the rights and wrong of this debate, just saying “leave it to the experts” will not do as a response.

    Neither will just “leave it to the politicians”.

  • Tony – possibly. But is engaging in crap contracts the exclusive preserve of the private sector?

  • @Richard Dean
    “Issues of weekend cover are not really the same as issues about fragmentation.”

    I think they are in the case of GP cover (although the fault for this is not this Bill or this Government but the last one). The service was fragmented to allow out of hours GP services to be provided outside of the GP Practice. This fragmentation has meant that where previously whoever was on call had theoretical access to your entire record now they may not.

    That said I still do not see what this post has to do with this Bill. I would have thought that post the Baby P scandal that erring on the side of caution and let the police decide.

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