The Rt Hon Earl Howe PC Parliamentary Under Secretary of State for Quality
Department of Health and Social Security
REF: Your letter to Mr Stride 9-02-15 PO00000912802
Dear Lord Howe,
Mr Stride forwarded your letter the next day (1) and suggested that I would want time to consider it. This reply is long delayed. The political landscape, and especially that of our NHS, changes by the mile as on a train. I see that the Efford Bill ran out of steam 3-03-15 so this letter will deal with a few central points. Incidentally, I have asked Mr Stride to correspond by e-mail. That would be better for the plebiscite in allowing the easy sharing of correspondence etc and be less costly. At the Westminster end it would save many of those precious millions including that spent on expensive, crested ivory paper. And governments ask often that we should use e-correspondence. Furthermore, it is driving the NHS into becoming inappropriately 'paperless'.
I have been 'considering' the NHS most days since leaving my full time post as a consultant orthopaedic and trauma surgeon through severe illness in 1993. I had been fighting the ridiculous and costly Internal Market, based as it was on a US template which had not been examined in depth. I was also fighting, with other consultants, for the life of our excellent 120 bed Princess Elizabeth Orthopaedic Hospital. Both battles were lost. Mental and physical exhaustion, accompanied by severe hypothyroidism, were central to that illness. (I spoke of this in my second letter to Mr Stride. (1) ) Happily I recovered and was then able to do part time surgical and clinical work in the service for twelve more years. The tragedy of induced illness goes on as you know with 44,000 NHS staff 'off sick' with depression etc due to a variety of oppressive causes in the NHS. Some dozens are likely to end their lives. The DoH and its executive arm, NHS England, should feel the greatest shame as the responsible authorities. The pecuniary cost of locums will be great. The suffering of these people and their families is incalculable, as will be the cost in morale, esprit de corps etc within the service.
When working in the 30 acres of woodland I planted/had planted in the 80s, my mind is often on our medical services and what is being done to them through 'market' dogma in particular. This is because I care very deeply about OUR NHS, about our country and about our world. I shrink when seeing fine things destroyed. I say the NHS is like a beautiful and vigorous flower. If it is crushed in the least way, it can never recover that beauty. I am constantly aware that if OUR NHS goes down, millions of poorer people will suffer great distress when they need medical services as they will. So as I work in bright sun and clean Atlantic air, looking now and again over the green of pasture and the ploughed red to the blue sea beyond Teignmouth, my duties and joy in my surgical work are still with me.
Bona fides of governments – fragments.
Milburn leaves his post to 'spend more time with his family' and Allied Medical for money. Labour > PFI - lead boots for decades – see Bart's, see many dozens. Mr Cameron – 2009 – 'it’s not a question of saying the NHS is safe in my hands. Tony Blair once explained his priority in three words: education, education, education. I can do it in three letters -NHS.' - 'no top down re-organisation of the NHS'. The Health and Social Care Act 2012 came in spite of this promise and should shame the Conservative and Liberal Democratic parties for ever. It was opposed by all professional bodies except typically the Royal College of Surgeons of England I believe. It was Richter Scale 10 and its cost, mostly hidden, is commensurate. Its complexity and obscurity is such that some in No 10 do not understand it. It must have been worked on for years with PwC (2), McKinsey, the DoH etc, and well before Mr Cameron's promisethat there would be NO top down re-organisation of our service.
Policy directives on the hoof.
One current example. Mr Cameron promises will be a 7 day service. (BBC mentions a higher percentage mortality at weekends but there are several factors in that.) As the BMA says there is a 7 day service especially as hospitals become busier all the while. The reality as I heard it – orthopaedic colleagues at the RD&E had three lists set up for Saturday am and pm, and the same for the Sunday in January. One stream for fracture patients (mostly hip fractures) and the other two for elective operations (THRs etc). The RD&E surgeons were doing what was required of it. ALL were cancelled – NO beds. This was in spite of 44 beds/2 wards being added in 2013, one ward being for the elderly awaiting a step-down bed in a Community Hospital, care home place or care in their own home. 'Delayed discharges' and norovirus caused the closure of one and a half wards that time. The waste of human resources and the cost can be measured but not the anxiety suffered in the patient. In spite of a dramatic reduction in post-op in-patient times there is not the leeway in bed occupancy that I knew for years was right ie around 85%. Furthermore, the bed numbers have been reduced by between 30 and 50% over twenty years.
Critical factors in delayed discharge
I note you are in the list to which NHS England copies the many statistics. As minister for quality you will be aware of all that I could say to you. You know most of the SW hospitals have had 'alerts', the worst being Derriford which has been on a black alert for at least 3 months (3) 1500 operations have been cancelled in the first two months alone. The safe and speedy discharge of patients from DGHs is vital for cost and to provide vacant beds for the press of patients needing admission for acute or elective reasons. Government policy is working against this and one therefore questions whether restriction of provision is the motive. Community hospitals perform several important functions as you know, the first being to take patients promptly at the request of the 'discharge' team at the DGH. At least 8 have been shut in Devon. I have played my part in urging that they thrive. 'Social' care has become a lottery. There are many factors but zero hours contracts, minimum wages, mileage mostly unpaid, no pension scheme and no professional development are the main ones. I know a good deal about this because our daughter is a carer. Finally, county care homes being closed and the fees of the private one are being driven down by the 'commissioners'. So some are closing. Lastly there is the GP contract negotiated by Labour which leaves people needing urgent attention at the weekend being funnelled instead by an inadequate 111 to the A&E departments.
The lawfulness, the morality and the absent principles of successive British governments.
No one should consider how a government stands without seeing the whole. This applies especially
in regard to OUR NHS. Contrary to the market ideology that all parties have attempted to impose, the NHS has a moral and principled basis. It adheres to those words of Christ - 'Love thy neighbour as yourself.' So in caring for and saving the lives of people here, we are bound to show the same respect for the lives of people abroad of whatever creed or colour. Instead, Blair the paramount psychopath, lead a massive bombardment and invasion of Iraq which killed over a million humans, maims by usual ratios over 2 million and causes 4 million to flee their homes. And a country of 30 million is destroyed forever. There was no law or compassion in that. The Charter of the UN and the Nuremberg Protocols were trampled in the sand. And your leader does the same. Hellfire and Cruise missiles and Paveway bombs 'pound' (a BBC euphemism) Sirte in Libya on a pretext. That was an aggressive war as defined by the Nuremberg Protocols and few in the House opposed it. That country is also broken for ever. And international law was abrogated by supporting mostly imported 'rebels' in attempting to overthrow President Doctor Bashar Assad with several million citizens fleeing Syria and over 100,000 killed. Such inhumanity and total disregard of international and moral law makes the present and previous administrations unfit to govern, and especially governing OUR NHS.
What I have spoken for over 20 years +
My 40 years of service as a doctor and surgeon, working in a variety of hospitals, led me to believe that the NHS should be at more than arms length from the government of the day.I could see clearly that the NHS was a political football which suffered most as each new group brought with it the baggage of its dogma, and the prejudices of its constituency.
The NHS should be headed by a scrupulously chosen executive, all members being professionals – nurses, carers, physiotherapists, doctors etc. Engineers, architects etc of excellence. All would be of the greatest probity and without any possible conflicts of interest. Instead their interests would be in heading the most rational and efficient NHS. Money would be allocated via it to the districts. They would have to make the best of it. The national executive would report to the Health Select Committee say 6 monthly. What has been achieved / what could have been done better/ actual failings / what specifically could be achieved with more funds. The DoH would be responsible for public health and for the assessment of standards thus removing the tick box CQC. The executive would thus be responsible to Parliament and through it to the whole country.
I attended a packed meeting at Lustleigh at Christmas. Dr Sarah Wollaston was speaking; she is widely respected and liked having practiced as a GP in the area. In question time I spoke briefly of my long held belief that the NHS should be separated from the government of the day. She responded firmly that what I had wanted was now in place. 'The DoH and government were separate from NHS England, the executive body. It was not the place to debate that further. A recent example that the political football is still in play was the sudden announcement by the Chancellor (not Mr Hunt) that £ 6 billion was being 'devolved' to Greater Manchester, the so called Devomanc'. That is one gross example. I read he had been having discussions with Manchester councillors for several months, as opposed to a small body from NHS England.
Vested interest or conflict of interest: some examples
Conflicts of interest have often been concealed. I exposed Mr Simmonds, MP for Boston and Skegness. He had been advising Circle Health for £12,500 and 10 hours per quarter. This was in his register of interests but he failed to speak of it when debating the H&SC Bill. Mr Lyon took it up and recorded another 'failure'. (4) He apologised. There are stricter sanctions for trivial misdemeanours in parish councils.
I recall that Lord Nash, before his elevation, gave c. £25,000 to Mr Lansley's Office. He had business interests relating to 'health care'. I think his wife gave a very large amount to Conservative funds.
With the red leather only in mind, I understand that at least 20 lords have pecuniary interests in businesses that are to do with medical services. Did they take part in debates on the bill and its amendments? Whatever they declared as interests, they should have retired from the chamber.
There is a widely held perception that governmental and parliamentary processes are corrupt.
This is one of several web sites that attempts to log where conflicts of interest might reside. (5)
Today Lord Warner is opining on the need to keep the NHS wide open to private firms. (6) In this Mail on Sunday article, his conflicts of interest go unmentioned.
Excellence within OUR NHS
a. A help mate of many years in the woods and garden suffered very severe sciatica last Spring. Suddenly at 3 months Mark developed some numbness in his saddle area and difficulty in passing urine. A 'cauda equina' lesion is a surgical emergency. He was sent to the RD&E (Exeter) rapidly. An MRI scanner was ready. The cause was confirmed. He went straight up to theatre where Mr Clarke performed a microdiscectomy. He went home the next day. He gradually returned to the most active manual work.
b. My son Andrew, aet 49, developed pain (unusually) in a long standing inguinal hernia. He saw his doctor 3 weeks ago who referred him immediately to the RD&E. The consultant saw him last week and offered him a 'cancellation' this last Thursday. He was allowed home the same day with long acting local anaesthetic in the wound and instructions to walk a good deal.
c. I have had a peripheral neuropathy for 2 years. It required definition as to its likely cause and a prognosis. The neurologist I saw at Plymouth, and the professor at Queens Square could not be bettered anywhere in the world.
d. My sister has been through the mill with a thyroidectomy for cancer and DXT. She awaits therapeutic I131. Voiceless, she has suffered 7 episodes of blocking of her airway causing her to press the Careline button. The paramedics have come immediately and have saved her life. She has the greatest praise for them.
A good deal of this excellence arises from the structure and systematic nature of OUR NHS. It must not be fragmented or undermined in any way.
The case of George Werb
The death of this 15 yr old boy under a train has haunted me since I learned of it. It encapsulates the neglect of government, especially of mental illness, and the ascendancy of 'private' medicine. It has happened against a backdrop of a 8% reduction in funding of care for mental illness. It is likely that 8% is an underestimate.
The full report by the Express and Echo (7), is of a previously bright and happy youth. After referral by his GP, George waited around 10 months until his first appointment with a doctor of the Child and Adolescent Mental Health Services (CAMHS). This is an outsourced outfit within the Branson empire. The psychiatrist prescribed anti-psychotic medication. In-patient treatment was needed. A place was found at Huntercombe near Maidenhead, 130 miles from his home. His parents removed him from there because the room was 'not fit for a dog'. He was unclean and still living out of his suitcase. He was then admitted to a Priory hospital in Southampton, 85 miles from home. The coroner criticised communication within the Priory, among other faults. A home visit was allowed after 5 weeks. No suicidal risk was considered to exist although his writings showed he 'wanted saving from himself'. He walked in front of a train, and I believe near his home.
Late in the day, the country is told that there will be extra funding for the treatment of mental illness, but the structures, particularly of skilled staffing, are unlikely to spring back into place.
The common sense and compassionate treatment of a child is a measure of the competence and heart of our society.
Some of these thoughts are contained in articles to the Western Morning News, the last being (8)
I end with some words that I use when speaking or writing publicly.
THESTRATEGY - DESTABILISE> DEMORALISE> DISMANTLE
To heal is a calling and caring for the sick
is a sacred human privilege and duty.
When we lift up the sick
and weary, everyone is lifted up
We must recover an NHS that is run on common sense and compassion
And cherish those who care for you.
Encourage them. We are all in it together.
And these are the billboards on our car
IFYOU CARE FOR OUR NHS THEN YOU WILL HAVE TO FIGHT FOR IT.
THE POLITICIANS HAVE IT BY THE THROAT.
FIND A CANDIDATE WHO IS INDEPENDENTOF PARTY, WHO HAS DONE A JOB,
HAS PRINCIPLE AND VISION, AND WHO WILL FIGHT FOR OUR NHS
AMONG OTHER THINGS THAT ARE VITAL TO US.
DAVID HALPIN MB BS FRCS 01364 661115
Dear Lord Howe. The NHS was founded in spite of the UK being exhausted and on its back in debt. It was founded on moral and humanitarian principles of the highest. The climate has changed completely. The rush of bribes to the electors gathers pace. The cynicism of it stinks. Take the Liberal Democrat promise to increase spending on mental health when it has been a coalition actor for 5 years whilst many have suffered and some died. Even many central things are lies; 'austerity' has not caused the national debt to drop. Instead as always that debt has risen as always intended.
Our country is demoralised, and in that it reflects those with power. Bevan's dictum fits – 'I have never regarded politics as the arena of morals. It is the arena of interest.' You and we must change that.
David S Halpin MB BS FRCS St Mary's London University
ccs Mr Mel Stride MP for Central Devon
Dr Sarah Wollaston MP for Totnes Chairman Health Select Committee
Web site of David Halpin - http://dhalpin.infoaction.org.uk/