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Letters: Doctors dispute the diagnosis for NHS change

I have resigned from general practice as a result of the damaging interference by this government in the running of the NHS which, for the first time since I had qualified in 1984, showed signs of improvement and progression as a result of Labour’s changes (What revolt? Cameron ready to force through NHS bill, 11 February). Patient care was improving markedly, resulting in reductions in waiting times, improved quality and speed of care, improvements in mortality and morbidity from chronic disease such as heart disease and cancer, with GPs and hospital doctors being able to see that their hard work had some effect over NHS outcomes. The NHS was going in the right direction, and the Conservatives promised in their pre-election campaign that they would not interfere with the NHS.

So it was a shock to me when the Conservatives got into power and quickly announced massive changes which had obviously been years in planning, with the intention of implementing them at breakneck speed. I was looking forward to Labour’s changes being improved upon during a period of stability in the NHS. The next major step should have been to address the health and social care of our increasing ageing population, but this should have been an evolutionary thing, with clinicians having the time to take part in planning the integration of health and social care against a stable background of successful evidence and outcome-based healthcare. Their time is now spent trying to grapple with huge changes which many of us feel are wrong for the NHS, with little time left to provide excellent patient care.

What also contributed to my resignation was a personal insight that I and my fellow GPs were going to be held responsible for the inevitable rationing of healthcare as the needs of our population increase, with the government washing its hands of that responsibility at the same time as imposing budget reductions on those to whom they had handed the management and future of the NHS. I simply was not willing to be set up to fail.
Name and address supplied

• If doctors in this country did indeed choose to follow the hippocratic oath which underlies their ethical code, they would have good grounds to refuse to participate in changes proposed by the health and social care bill. The World Medical Association Declaration of Geneva (1948/1968) states that “I will not permit considerations of … party politics … to intervene between my duty and my patient.”

A main disputed component of the bill is the aim to cut cost by introducing competition through the private sector. This reduction of cost bears no direct relation to the clinical effectiveness of the treatment of patients which forms a duty in the hippocratic oath. This duty is currently being addressed effectively within the NHS through its development of a future clinically integrated care programme. This patient welfare component of future treatment – which will lead for example to the creation of fully integrated multidisciplinary teams (rather than low-cost single service units) – will be vital to future medical and healthcare practice, but is not likely to fit into the narrow criteria of cost-effectiveness proposed by the bill. Equally, the closure of this welfare component within the NHS itself will undoubtedly contravene medical and healthcare ethics, but not the ethics of government, politicians, or service commissioning managers.
Dr Martin Stanton
Visiting professor, Roehampton University

• As a junior doctor, I was disturbed by the selective and biased nature of Ali Parsa’s comments (We believe the NHS is a professional service ripe for re-engineering, 9 February). His assertion that insecurity is the basis for objections to the white paper by medical professionals shows limited understanding of the sector. The true basis is the frantic nature of a restructuring which remains nebulous in terms of intended outcomes. That the much vaunted commissioning by GPs is now seen to rely largely on outsourcing to private companies affords legitimacy to these concerns.

Parsa’s apparent use of nominal rather than inflation-adjusted expenditure data is deceptive, as is his presentation of inefficiency as the primary driver of rising expenditure, rather than multiple influences including an ageing population and more advanced treatments. Equally curious is the suggestion of deregulation/privatisation as the solution, given the comparative costliness of one of the world’s most privatised systems – that of the US.

I can understand the intensity of Parsa’s lobbying: if the bill proceeds he will have a lot to feel smug about, as private enterprises such as those he manages feed on the opportunities created by the dismantling of our NHS.
Dr Aideen O’Neill

• It’s no surprise “the left is in trouble” (A life on the left, 11 February) if it fails to make a convincing argument against the right. Stuart Hall bemoans the loss of “the principle that someone shouldn’t profit from someone else’s ill health”. What’s wrong with someone profiting if they can provide the same health outcome for less?

What about the value for money principle that allows us to get more healthcare for the same expenditure? We’re going to need to do exactly that to have any hope of funding the ever increasing health demands of an ageing population. Also, isn’t it morally wrong to saddle the next generation with the interest payments on the debt we incurred to fund our services?
Barnaby Benson

• So Simon Hughes wants Andrew Lansley to resign after the unpopular and damaging health bill becomes law (Report, 13 February). Hughes would be doing the country a far greater service if he just told his party’s MPs to vote against this dreadful piece of legislation.
Phillip Cooper
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