Tuesday 15 May 2012

The Chilling Effect: telling the truth about the future of health care in Broken Barnet

Dr Death: Andrew Lansley and his NHS reforms

Mrs Angry has had the misfortune, over the last few months, of experiencing at first hand the rapidly worsening state of healthcare provision in this borough. She has witnessed, in increasing horror, the way in which the conditions of not just herself but a close family friend, and now a family member, have been ignored or continually delayed directly as a result of the current system of prioritisation of access to consultant care, a new system which, as a direct result of new government guidelines, effectively restricts access within a reasonable period of time to only a very few patients - those who are clearly demonstrating signs of a life threatening illness.

In her own case, an unknown condition deemed by the GP to need an emergency scan only received one after four weeks, and a lot of yelling. Scans, it was explained, even urgent ones, were being 'rationed'. She then had to wait four months before seeing a consultant, in a stand up appointment lasting five minutes at the most.

The family friend died before she ever got to see the consultant.

Now a family member, X, has been waiting eight months, still without seeing a consultant, despite being identified through tests as having a distressing and debilitating condition. That any tests were done at all, eventually, was only due to Mrs Angry losing her temper in the GP's surgery, and asking, with venomous irony, if it was really cost effective, and in line with budget demands, to wait until X collapsed and had to be admitted to hospital? Weeks ago an urgent appointment was asked for on X's behalf. After the results of tests last week, and despite promises from the hospital concerned, still no contact has been made. Oh: instant update, this consultant, informed that a formal complaint will be made if no response is received, now says the letter 'got lost' ... really? How unfortunate. And another week's wait, despite X's state of health.

The unpleasant truth about the state of healthcare now in Barnet, and presumably elsewhere, is this: if you are seriously ill, unless your GP thinks you have cancer, you cannot be 'fast tracked' to see a consultant within a reasonable period of time. You will have to wait the maximum period of around eighteen weeks. This will apply no matter how ill you are, how much pain or discomfort you are in, no matter what impact your condition has on your quality of life, or even your mobility. Even to be referred in the first place will be a struggle, as the system is brilliantly organised so as to delay the point at which you can be referred even to a waiting list, no doubt in order to fudge the statistics.

Whether or not you survive this delay is a matter of chance, and a matter of how able your GP is to guess, without a full range of tests, and the professional assessment of a specialist, quite how ill you are, sitting there in front of her desk. You might wonder how a GP can be certain that you do not have cancer, without proper assessment, and of course you are right. It is an impossible situation to put them in, and a huge responsibility.

How many patients have died, or will die unnecessarily as a result of the rationing of healthcare we are seeing now, through delays caused by the new guidelines? How much distress, pain and discomfort is being caused to residents who are ill but made to wait more than four months to see a specialist?

Of course if you have full private health cover, you need not worry about any of this. You can expect to see the same consultants everyone else waits months to see in a couple of days, at a local private hospital. Unfortunately, even if you can afford this, it is not always appropriate: it is also apparently sometimes the case that if you seek to bypass the NHS system with a private consultation, you may even find yourself withdrawn from the waiting list.

So: as with education, and almost everything else in this borough, those with means have access to proper services, those without are f*cked.

Ah, but, you may be thinking, does the government not have wonderful plans for our NHS, and are David Cameron and Andrew Lansley not promising us that their assault on the founding principles of the NHS will bring us reform and a fabulous new future?

Yes. Wonderful plans. Plans similar to the One Barnet outsourcing concept: handing over the delivery of vital services to the private sector, which means that profit will have to be made for shareholders from the provision of healthcare.

The lie of the Caolition government's plans is that the reforms, which will demand more than £1.5 billion alone for the cost of staff redundancies, will be giving control of healthcare to GPs.

In fact, control - and tax payers' money - will be in the hands of management consultants and private healthcare companies. GPs will have to submit monthly accounts, and be even more aware of the budget costs of every clinical decision they make, and the need to justify, and yes, ration, the tests and treatment and medication they approve. The new emphasis on a move away from acute hospital care to localised clinics will mean even less access to specialist consultant care.

Bearing in mind the state of healthcare in this borough now, do you trust this government with the future of the NHS? Will there even be an NHS in anything but name?

Look at the list of bodies who have come out and said they oppose these so called reforms: the BMA, the Royal College of Nursing, the Royal College of Midwives, the Royal College of Paediatricians, the Royal College of General Practitoners, Unison, Unite ... but of course Mr Lansley and Mr Cameron know best, don't they?

Do they? How would we know? How can we come to an informed decision about these proposals? Well, in short, the answer is we cannot, because the goverment has refused to publish the risk register which would tell us how likely it is that their plans are anything other than a catastrophe waiting to happen, and a complete betrayal of the best interests of every ordinary resident, that is to say, every resident who cannot, unlike the Coalition ministers pushing this through, rely on the privilege of private health protection.

The Information Commissioner, as you can read in a blogpost today here by David Hencke, has now laid before Parliament his views on the ministerial veto exercised by Andrew Lansley in order to prevent publication of the risk register. As the ICO response observes:

7.5 The Secretary of State also said that if risk registers were routinely or regularly disclosed, or there was a concern that they could be, then it was likely that the form and content of such registers would be changed to the detriment of good government. This is an argument that is commonly referred to as the “chilling effect”.

In other words, the government ludicrously asserts that it is in the public interest for the truth about the risks of their NHS plans to be withheld from the public domain, and that on this issue, one of such unprecedented significance for every man, woman and child in the country, there can and will be no transparency.

The Information Commissioner utterly rejects this argument - and so it should.

There is, of course, deep disquiet even amongst many Tories about the NHS reforms. There are, however, one or two MPs who are prepared to ignore the voews of constituents, warnings from local GPs and health professionals, and indulge an inexplicable desire to support the government in this matter. Step forward, for example, Tory MP for Finchley and Golders Green, Mr Mike Freer.*

Speaking earlier this year in Parliament, in defence of the refusal to release the risk register, Freer said:

"The release of the risk register is seen as an opportunity by the opposition to cherry-pick doomsday scenarios the register may contain. It is simply a charter for shroud-waving."

Mrs Angry thinks perhaps Mr Freer may wish to consider the recent political demise of his chum Brian Coleman, and wonder whether he should get himself fitted for his own shroud, ready for the next election.

Funnily enough doomsday in Barnet is a theme in a Guardian article today, see here in which Tory council leader Cornelius' awful phrase, the 'Graph of Doom' is used as a heading , prophesying a bleak future of bankruptcy due to an annoying surplus of too many older people, children and dependent vulnerable residents. Yes, Brian: 'these people', again, causing trouble.

Mrs Angry suggests all is not as bad as it sounds, however. The one bonus of the present state of chaos in healthcare in Barnet, and the promise of more to come in the future, once the unknown mysteries of the NHS reforms are in place, is that more and more of those affected by social exclusion, age, youth, disability and ill health are likely to be mercilessly culled by a system that can no longer address their needs. That will relieve some of the burden on our One Barnet service providers, we imagine.

Welcome to Broken Barnet, the next generation.

If you think things are bad now, wait until tomorrow.

* If you think you might like to explain to Mr Mike Freer, MP, why you object to his pathetic defence of the withholding of the risk register, and his references to 'shroud waving', why not write to him and tell him, especially if you are a constituent.


or you can tweet to: @mikefreermp

Mrs Angry is sure he will be pleased to hear from you. Do pass on her good wishes.

Updated: 21st May

Question: how do you get to see a consultant, in Barnet, after nearly 9 months of serious ill health, a preliminary diagnosis of a chronic condition, a 'lost' urgent referral, a false promise of an emergency appointment, and still no contact?

Answer: you are obliged to lose your temper - again - with your GP, who loses her temper with the hospital, who then tells you the consultant, who last week thought you should be admitted to hospital, will grudgingly see you at A& E the next day. Maybe.

This is how the NHS now operates, at least in this borough: months of prevarication and refusal to give access to the appropriate testing, on grounds of budget restrictions, then an avoidance of accepting referrals to see consultants so as to fudge the waiting times, and then finally a preference for admittance to hospital or A&E consultation, (different budget, no doubt) when the patient is reduced to an even more severely affected state of health. If the patient pegs it in the meanwhile, one less number on the waiting list: success.

Live in Broken Barnet, without private health cover?

Be afraid: be very afraid. If things are this bad now, do you think they are going to get any better after Lansley really gets going with his 'reforms'?

Local MP Mike Freer has blocked Mrs Angry on twitter, since writing this post.

I wonder why.

You can stick your fingers in your ears, but please don't think that is going to shut me up, Mr Freer.

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