Your report (Boris Johnson plans radical shake-up of NHS in bid to regain more direct control, 10 July) states that one goal is to increase the health secretary’s “powers of direction” over NHS England. This is alarming when we look at what happened with the Covid-19 hospital discharge service requirements, issued on 19 March. These draconian provisions show that there was a concerted attempt to decant patients en masse.
Doctors were not simply assessing individuals. Trusts were required to discharge patients without a Covid-19 test, to scrap the normal time frame for planning discharges and to ignore eligibility criteria for admission to care homes. Local authorities were required to take patients without an assessment under the 2014 Care Act. It suspended “usual patient funding eligibility criteria” and took away patient choice of home.
The stated purpose of these discharges was to reduce pressure on acute services, not to meet the clinical and social needs of older people. NHS public funds distributed from the centre were used to bulk-buy places in homes, and both discharge and admission criteria were compromised. Older people were also to be diverted from hospital: the requirements stated that the provisions applied for people who would otherwise be admitted.
No guidance was given to patients or relatives on the costs that they might incur in financing care they did not choose. These elderly patients were not assessed correctly, their rights were seriously abused and they were then placed in a confined context in which the virus was likely to exist, and were put in contact with untested staff. Did all these elderly patients give informed consent? Many died in homes.
Boris Johnson has denied that this was a “concerted effort” and Matt Hancock claims to have put a “protective ring” around care homes, and they now seek to intervene further in the NHS through more powers. The prospect of policymaking by diktat of this kind – centrally driven, and overriding existing legislation – is alarming. Protecting NHS independence will protect patients’ rights.
Fellow in health services management, The King’s Fund 1993-2002
• Even with this government’s track record of hypocrisy, deception, cover-ups, rewriting of history and blame-shifting, it still beggars belief to see the prime minister and health secretary presenting themselves as the frustrated victims of an overweening NHS England, rather than its enthusiastic creators, through the 2012 Health and Social Care Act.
If Boris Johnson and Matt Hancock really want the government to take back control of the NHS, the remedy is readily available to them. As many have suggested, they could start by revoking the totality of the Health and Social Care Act and restore the health secretary’s responsibility to provide a free, comprehensive and universally available health service. From this, a full reinstatement of the NHS as a publicly funded, publicly run and properly accountable national service could start to be rebuilt – and transformed for the future.
The only problem for them would be that they would no longer be able to award huge NHS contracts to inefficient private companies like Serco that are only too happy to be cementing their place in the NHS supply chain. They couldn’t applaud the dedication of NHS staff while refusing to implement proper pay, conditions and respect for all levels of NHS employees. They couldn’t talk of the integration of NHS services while proposing to make new legal entities of the integrated care systems that actually open it up to further privatisation and fragmentation. They couldn’t continue to have the NHS on the table in US trade talks while denying that this is the case.
The Tories have spent the last 10 years doing their level best to dismantle and destroy the NHS. Their proposals are merely technocratic and do nothing to honour the values of Nye Bevan’s founding vision.
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