"The NHS will last as long as there are folk left with the faith to fight for it"
Aneurin Bevan

Saturday, 4 February 2012

Why Patients Are Not Objecting To The Health Bill

There is a some bemusement from clinicians as to why the public - patients - are not objecting to the health bill. As a patient with a long term condition, I will explain why.

NHS patients treat the NHS like mains-supplied water. When you need it, it is there. Turn the tap on, and the water flows. Go to your doctor and get treated. You don't have to think how either is provided. You don't think about how it is funded. (Even people on metered water don't think: flushing this toilet will cost me 1p.) You know it is there and you use it when you need it.

And that is exactly how it should be.

But it will change under the Health and Social Care Bill.

The problem is that when fundamental changes are suggested, like with the Bill, patients do not understand the issues, because they should not need to understand the issues, they just want to be assured that when they go to their doctor they will get treated. And this vital, and deeply held belief that the NHS is always there for them, is too ingrained for patients to ever countenance that it may be at risk. Yet it is.

If a politician issues a platitude like "no decision about me, without me" patients will take that as reassurance. The deeply held view that the NHS will always be there for them means that patients do not demand from the politician that there is a guarantee that all the care they need will be provided. And they should do, because the whole point of the Bill is to remove that guarantee.

Sir David Nicholson's announcement that CCGs will be allowed to provide only the services that they want to provide and not what their patients need, should have resulted in an outcry from patients. Yet there was none.

Lansley's weak and ineffectual attempt to get private clinics to act responsibly and remove the substandard PIP implants that they had used should have been a warning to patients that the same will happen when unaccountable private providers are introduced to the NHS. Yet there was no outcry from patients.

Patients assume that the NHS will always provide for them. They cannot believe that the politicians they have elected could possibly bring in a system that will remove their access to some treatments. Similarly, you could never believe that you'll be in the situation that when you turn on the tap there's a chance that nothing will come out. We assume the tap will always provide water and we assume the NHS will always provide care.

Patients believe that the NHS will always be there for them: and that is how it should be. This deeply held belief is the reason why patients are not objecting to a Bill that will result in an NHS that is no longer there for them.


  1. I see it as very similar to the railway privatisation. Hardly a murmur from the general public at the time, but now...

    Basically the English are very good at complaining after the event. They are not very good at getting off their bums unless the problem affects them directly and immediately (eg. wind farms). I believe they live their lives believing that all the nasty things will happen to someone else. They (we) are in for a nasty shock.

    Ben Goldacre has said "Lansley is the Dr Beeching of the NHS. His name will be remembered long after we are all dead." How true.

  2. Mind you, after this bill's passed a lot of us could be dead pretty quickly. Whose responsibility will it be to provide me and the other thyroid patients with the thryroxine we need to stay alive, hmmmm? Currently it's free on the NHS. Bet it won't be after the bill's passed. At what price will it be available. Will it be available? Who's to say?

  3. @Bill I take thyroxine too. Actually, it is very cheap, a months supply is about a quid. It's interesting to search on the internet the medicines you take and then compare how much that is compared to prescription charges. Some medicines are costly, many are very cheap. If we want to share the cost of the most expensive drugs, then why not do that through general taxation? Instead, it is only patients who pay prescription charges. Note that the government has no intention of reforming prescription charges. Funny that.

  4. My personal experience is that patients are noticing the local NHS changes (restructuring, transference out of the NHS,reduced staff, increased waits) but are not equating this with the general drive toward the Bill; a bill that is the culmination of all that has been going on. The stuff they are noticing is the preparation for the Bill - they do not see the connection

    1. As Mary Taylor said, things are becoming noticable to the local general public level now but the blame is being put on the local NHS Trusts etc. Lansley and the rest of his ilk are not stupid, they're pushing this and other policies through in a manner that allows them to stand back whilst others are forced to do their dirty work and become the targets for blame instead and the systems they are setting up are designed to do the same.

  5. "And this vital, and deeply held belief that the NHS is always there for them, is too ingrained for patients to ever countenance that it may be at risk. Yet it is."

    Yep. This is the problem.
    Ultimately the NHS is a victim of it's own success.
    I get so angry because those that knock the NHS (like Lansley) do in an entirely uninformed way. I suspect, however that Lansley himself is not uninformed. And that is what really scares me.

    Please, please can we save our NHS....

    As said above, Lansley is the NHS's Beeching.


  6. I find that as a layman, there is little information/publicity about what is actually going to happen in practical terms. Lots of airy fairy stuff, but no real detail. Maybe the profesionals ought to address this and inform the public. Then we can protest!

  7. @ADDY I agree. I have tried to explain as much as I can on this blog over the last couple of years.

    In the following False Economy blog I have tried to give a dispassionate explanation of the main parts of the Bill with clause numbers so that you can look up the clauses yourself:


  8. Thank you. I am off to study this now.

  9. There has been not public outcry because the most trusted medium in the UK - the BBC - is reporting it in an incredibly 'passive' manner.

    No heated debates or analysis of what might happen. Just pictures of Lansley and Cameron smiling and telling us they LOVE the NHS.


    At least the Guardian has given a few warnings.

    What is in this 'risk register' that Lansley is refusing to publish?

  10. "NHS administrators treat the taxpayers money like mains-supplied water. When you need it, it is there. Turn the tap on, and the water flows. Go to your government and get funded. You don't have to think how either is provided. You don't think about how it is appropriated."

    Would you, an NHS patient, hold a gun to the head of another citizen and demand half his earnings? Why then do you allow the government to do it on your behalf? You can make as many arguements as you want, but the humanitarian ends do not justify the violent and oppressive means - the government uses the implicit threat of coercion and restriction of individual freedoms to force peaceable people into handing over their resources.

    Privatising healthcare leads to a more voluntary society. Competition between private companies shifts their funding motivation from demonstrating need to government, to optimising care and providing value for money. Removing the overhead of tax collection and centralisation from the NHS would dramatically increase the value for money that patients get from the NHS.

    1. You're a nut.

      The only people I have heard this ludicrous argument of "hold a gun to the head ... and demand half your earnings" were Tea Party Americans I know. In America tax collectors may well be armed. In the UK they are not. privatising healthcare will lead to health inequalities on an unimaginable scale. And you are clueless about the cost of tax collection - it is far cheaper to collect tax than it is to collection insurance premiums or self pay.

  11. This comment has been removed by a blog administrator.

    1. There is no evidence at all that privatising healthcare will lead to "a more voluntary society". If that is what you want, then why not mandate that ALL companies are non-for-profit and that executive boards are paid no remuneration? All the evidence is that competition between private providers leads to a race to the bottom, and leads to worst care rather than better. The NHS is one of the most efficient and cost-effective healthcare systems (ample evidence here - most recently on the number of lives saved per £ spent per capita) in the world and the reason for that (as any health economist will tell you) comes about by having a single payer that imposes a limit to the money that can be spent. These are the hallmarks of a taxpayer funded system and is totally antithetical to insurance of self pay.

      You do not want "a more voluntary society" what you want to do is asset strip our state NHS and put a sickness tax on the poor through self-pay, co-pay and health insurance. There is ample evidence of what I mention - it is called the US.

    2. Oops, it turns out that the comment from Z was simply spam to a website that sold prescription drugs. However, my reply still stands