WE’RE CALLING ON ALL OUR SUPPORTERS TO URGENTLY RESPOND TO THE NHS LONDON ‘CALL TO ACTION’ CONSULTATION QUESTIONNAIRE
The deadline for responses is 31 December. We ask you all to read the explanations below and fill out the responses accordingly.

The Questionnaire can be found at:
https://www.engage.england.nhs.uk/consultation/23f64380/consultation/subpage.2013-10-11.6257925933/view
But please read our explanations before filling it out.

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Our explanation – the need to respond

The NHS faces £20 billion of dangerous cuts over five years. (1) Privatisation is being rapidly increased (2).

We should be celebrating and cherishing our aging population and baby boom.  But despite the increased need for care this creates, the government attempts to close hospital beds, A&Es (3) and maternity units (4).  At the same time, they continue to bleed our NHS budget with PFI debts (5)

Despite pre-election pledges from all parties that they would not reorganise the NHS or close local hospitals, they have conducted consultations that put 9 of London’s A&E’s at risk of closure (6).  These consultations, which affect the health of millions, often have a tiny amount of respondents- many of whom have a vested interest in the NHS being privatised.

The Save Lewisham Hospital campaign has produced these suggested responses to help people quickly reply to the leading questions in the NHS London consultation.  If you believe the government needs to invest more in the NHS- rather than distort clinical issues so that they can be used to push for further cuts, closures and privatisation – these answers are for you!

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Question 1  I would like a greater proportion of the health budget to be spent on keeping people from becoming unwell, even if it means there is less spent on hospital-based care

(Subtext: push for massive hospital cuts, based on hypothetical investment in primary care, rather than evidence.)

Answer

• This is not an either/or.  If keeping people well requires more primary care funding, I want an increase in NHS spending, rather than increase in proportion from a declining NHS budget.  I would also suggest renegotiating or  annulling  PFI. There is no evidence that better community care, even though that is  desirable thing, significantly reduces hospital admissions.
• There would be enough money for both hospital and community care if the overnment stopped squndering it on private consultancy firms, unwanted top down reorganisaitons, privatisation and Private Finance Inititaive deals.

Question 2 The NHS should ensure that it cares for people who are the least healthy, regardless of where they live in London.
(Subtext: your nearest hospital may be cut, so you could go to a larger hospital with ‘specialist’ services, further from home.)

Answer I would like the least healthy people to receive good quality hospital care at their local hospital.  These should all be of a high standard, to avoid a two-tier system.  The vast majority of acute medical and surgical problems are best treated in a district general hospital.  The strain which travelling puts on patients and their loved ones is not insignificant.  And the proposed concentration of hospital services in fewer hospitals means a reduction in hospital beds and the loss of specialist emergency staff from local hospitals – which will mean longer waiting lists, more congested A&Es, and maternity closures.

Question 3 How can the health and care services support people to be more in control of their own care?
(Subtext: NHS London prefers competition between services and wants patients to have their own budgets- which means the most vulnerable and unwell people will have to negotiate a ‘shopping experience’ with predatory health companies in order to decide their essential care.  This is a more costly, less efficient way of providing healthcare than having NHS services)

Answer Well-trained, rather than overworked, staff can better support patients to be involved in their clinical decisions.  By making sure NHS services are well-resourced, GPs and other clinicians can focus on helping their patients negotiate important decisions.  Commissioning services will suck time and money from clinical services

Question 4 How can the health and care services support people to take more responsibility for their own health?

(Subtext: there are many groups who call for penalties or fees to be applied to drinkers/smokers.  Jeremy Hunt signed up to a plan that calls for patients to have to pay for their healthcare out of their savings, so that sick people are forced to think about ‘the cost consequences of their decisions’ 7 )

Answer A patient’s responsibility and self-efficacy are likely to have inorganic/non-biological causes.  Research suggests there are classes or groups of people where health outcomes are worse and who are more likely to engage in activities that risk their health.  So instead of targeting help at individuals in a sort of health meritocracy, services should be targeted at the classes or groups with worse outcomes.  An increase in service provision and education in impoverished areas, perhaps coupled with increased training and incentives for staff to encourage them to work in these areas, would lead to an increase in healthy behaviors

Question 5 Mobile, smartphone and computer technology are now a part of life. Please give us your views on how the NHS and care services could better use this type of technology. For example, would you use it? What for?

(Subtext – answer this one or ignore it, there may not be a massive subtext.)

Answer Technology is good.  However, throwing money at technology corporations has cost the NHS £billions and been poor value for money.  I just ask that people are realistic about what they are trying to achieve and get good value for the taxpayer. There is no evidence that “telemedicine” with remote monitoring of people’s blood pressure etc. at home actually improves care or reduces hospital admissions. This could be an excuse for further cut back on human contact – and that’s what people really want and need – contact with health care professionals not machines. Machines can help but they can’t replace people when it comes to providing care in hospital or in the community.

Question 6 What do you see as the advantages and disadvantages of providing the same quality of care at the weekend and overnight as well as during the week?

(Subtext: Jeremy Hunt uses research about increased mortality rates etc to push through attacks on NHS staff conditions)

Answer

• Any change in working hours needs to have sound clinical reasoning and be fully supported by all the unions that represent the healthcare workers whose working hours, terms and conditions would be changed.
• The Government should invest in ensuring sufficient staf are available at weekends and during the week, including employing more doctors, nurses and other health care professionals if needed. They should not use staffing levels as an excuse to close hospitals.

Question 7 Thinking about health and care services, what three things would make the biggest difference in improving patient experience?

Answer

• Location – services close to home. Most people’s hospital care needs are best met by a District General Hospital close to where they live.
•  NHS services – seeing the same practitioners and seeing services that are part of the same organisation means they can communicate easily with one another.  NHS services are more likely to ensure continuity of care. We want joined up wrking and good collaboration – not competition and fragmentation.
• Cost – services not being charged for such as hearing aid replacements.

Question 8 How do you think the NHS should get better value for money?

Answer Less spending on commissioning and more on front line services.  Before the Health and Social Care Act was introduced, the NHS was the second most cost-effective healthcare system according to the Journal of the Royal Society of Medicine (8) and the Commonwealth Fund (9)

Question 9 Technology and our understanding of disease and treatments are changing fast. But changing services (and in particular the location of services) in the NHS can be a very long process. How could we speed up the process?

(Subtext – the government wants to make judicial review more difficult, so people can’t appeal unlawful decisions such as Lewisham’s.  They are trying to amend the Care Act to allow the Administrators to force changes on any hospital trust they like and avoid having a proper consultation.)

 Answer It is imperative that changes are accountable, democratic and clinically sound.  We live in a democracy, rather than a technocracy, thus there is no reason for bureucrats to impose change without going through thorough democratic processes.  The disgraceful attempt to close Lewisham Hospital with a paucity of clinical support or evidence should never be allowed.  Processes such as the TSA should not be used to bypass proper consultation, as is planned with the current Care Bill Amendment.  Further to that, the powers of judicial review should not be weakened.

Question 10 In the previous pages we have described a range of health challenges. Some of these are common across the country. Some are quite particular to London. What do you think are the main challenges for London? Have we described them in this document?

(Subtext – the document goes on about ageing populations, long-term conditions and increased expectations.  Though it provides false answers to these questions)

Answer

• Shortage of hospital beds.  Hospitals are under-resourced, under-staffed and lack capacity to deal with even the ‘baseline’ number of hospital admissions today.  Hypothetical improvements in community care and health promotion are not a reason to shut hospital services.  The time to consult on hospital bed closures will be when the number of admissions decreases, not before.
• People’s expectations.  The DoH could campaign about the evidence that NHS is the second most cost-effective healthcare system in the world.  People receive a lot of care without fear of being denied on account of income, and more could be done for people to understand that universality means people from all socio-economic groups will have to wait as long as each other.  So if they want to have it all and have it now, they will have to want everyone to have it all and have it now.
• Drastic cuts to social services (20%) which make it more difficult to discharge people from hospital and provide the care and support they need at home. This leads to “bed blocking” so there are even fewer beds to admit people into which causes back pressure in A+E and ambulances not being able to transfer patients into A+E. the social care cuts must be reversed. Social care must be adequately funded.

Question 11 Thinking about the NHS as a whole: What have we got right? Where are we going wrong? What or where do we need to focus on?
(Subtext – this is asking for a fig leaf.  The field of medical research is immense, measuring needs and outcomes.  There are experts and researchers working very hard to work out where money needs to be invested.  This question is trying to provide a similar weighting to the biased cohort of people who complete this questionnaire, rather than the patient surveys that already exist)

Answer Health epidemiology, inspections, evidence-based research and patient involvement provide answers to this question.  Taking answers from an internet questionnaire (which will undoubtedly be circulated to workers at private companies with a vested interest in a certain type of NHS reform) is a biased and incorrect method for answering this.

Question 12  Please indicate the response that most closely matches your views regarding the following statement:

Leave this question blank, it is meaningless and will be used in press releases to try and justify whatever dangerous changes they propose.

Questions 13 onwards are personal information, answer with your details – especially if you work in the NHS!

Thanks for reading this – let’s keep our NHS!