Clik here to view.
The government claims the public's voice is at the centre of its reformed health and social care system (Report, 25 February), and Healthwatch will be the vehicle that enables this. Healthwatch will seek the public's views to influence providers, commissioners and regulators. Evolving from the current Local Involvement Networks, its volunteers will have significant powers to inspect services with or without notice. To be credible, it's essential that Healthwatch be independent of those it will scrutinise, yet the government's proposals mean this now looks unlikely.
The government wishes Healthwatch England, the national body, to be made a committee of the Care Quality Commission and its chair to be a non-executive director of the CQC. Further, each local Healthwatch, tasked with monitoring social care provided by a local authority, will itself be commissioned by, and funded at the discretion of this same authority. In both cases there is a conflict of interest. Will a local Healthwatch dare speak up against its funder? Can Healthwatch England be an effective critic of the CQC when it is a part of it? Does the CQC have the capacity to take on a further burden, especially one so removed from its current activities?
Healthwatch will only be considered the true voice of the pubic, if it is seen to be independent of those it monitors. A local Healthwatch must be accountable to users of the services, not those who provide them. Healthwatch England must be answerable to the public, via elections from local Healthwatches. We urge the government to reconsider its position and allow the public voice to be heard as clearly as it claims it wishes, and the Lords to assist by amending the health bill accordingly.
Jeremy Ambache, Ann Bisbrown-Lee, Chris Boote, Michael Hewins, Anita Higham, Nicholas Kennedy, Jim Kerr, Mike McNulty, Dag Saunders, Jane Stubbings Elected representatives of Local Involvement Networks on the Healthwatch advisory committee, Alexander Marsden, Ruth Marsden National Association of LINk Members
• I'm sorry Zoe Williams (25 February) found an article that Zack Cooper and I wrote about the reaction to the NHS bill "dispiriting" (the more so since I usually find her articles rather uplifting!). But I am even more distressed that she went on to imply that those who supported the bill endorsed the idea of paying for healthcare, and did not care for the principle of equal treatment regardless of wealth.
I cannot speak for others, but I must be allowed to correct this impression of my beliefs. I have always held as a fundamental principle equal treatment for equal need, regardless of income or wealth, and have consistently opposed proposals for charging for healthcare, or for replacing or complementing the NHS by some form of private health insurance. What I do believe in is obtaining the best possible healthcare for all NHS patients; and I believe that a good way to do this is through the challenge to public hospitals provided by competition between them. This last belief is not based on intuition, but on an increasing amount of evidence that the choice and competition reforms introduced by the last Labour government, to which I was an adviser, have succeeded in saving lives, while having no adverse consequences for equality (indeed, if anything, contributing to slightly less inequality): a verdict endorsed in a recent book evaluating those reforms published by the King's Fund.
With respect to the NHS bill, it is important that even those who generally prefer to rely upon their intuitions should avoid muddying the waters by accusing the bill of doing things that it does not, like privatising the NHS; and that all those involved should acknowledge the peer-reviewed evidence demonstrating that its provisions with respect to public competition, at least, are likely to improve patient care – and may even distribute it more equitably.
Professor Julian Le Grand
London School of Economics
• I find the logic of your editorial (23 February) somewhat lacking. Neither vested interests nor the vagaries of public opinion can be allowed by an honest government to stand in the way of difficult decisions. On your logic, the unions would still be holding us all to ransom, the Bank of England would remain under the government's thumb, and Saddam Hussein and Gaddafi would still be in business. Radical reform of the NHS is essential. The proposed reforms are rational and modest. The lurid and shameless resistance movement has been managed by the usual suspects. Unless the NHS is at long last de-Sovietised, it will collapse in bankrupt ruin, to be followed by thoroughgoing privatisation.
Professor David Marsland
Reading
• Along with his Tory and Lib Dem colleagues, Simon Burns (Letters, 24 February) is overseeing a massive reorganisation of the NHS in the guise of a health bill opposed by virtually every profession in the NHS. Who do you trust more – your politician or your doctor? I am a GP who has been involved in commissioning in Lancaster for five years. We have been making big improvements to local healthcare, but we have been doing it without the need for further legislation. There is no need for this complex pro-market bill that will open up the NHS to the transnational companies just waiting in the wings to grab some of the £110bn NHS budget. GPs want to preserve the NHS as an equitable provider of care and to improve the NHS for their patients, but they do not support this bill. It needs to be put out of its misery and then we can all get on and improve the NHS.
Dr David Wrigley
Carnforth, Lancashire
• Before the last election, on 2 November 2009, David Cameron told the Royal College of Pathologists: "With the Conservatives there will be no more of the tiresome, meddlesome, top-down restructures that have dominated the last decade of the NHS." After that election, the new government's July white paper, Equity and Excellence; Liberating the NHS, proposed the biggest reorganisation of the NHS in its history. Clearly, Mr Cameron is not a man of his word in this matter and perpetrated a great deception on the electorate in his bid to become prime minister. The issue that concerns me, therefore, is not about the NHS, but about the prime minister's integrity. Isn't this the sort of dishonest behaviour that causes people to feel cynical about politics and to hold politicians in low regard, thereby undermining democracy? If the holder of the highest office in the land is untrustworthy, how shall public confidence and stability be maintained?
Charles Becker
Plymouth
• How cynical can the health secretary be (Lansley wins backing not to reveal risk register, 23 February)? Risk assessments only have utility when exposed to critical evaluation and their requiring disclosure does not mean they must be "bland and anodyne", if they are properly written with all caveats explained. If those involved are frank and open about potential risk, then their reasoning would be justified and any worst-case scenarios pitched accordingly. However, poorly written reports will be destroyed in public debate. The only people who need to be fearful will be those whose case will fail public examination. Do we have a fearful executive or incompetent risk reporters? Either way concerned parties deserve to be fully informed.
Dr Roger Bolton
Macclesfield, Cheshire
• The government claims its "reforms" will improve patient choice. If so, then the government must urgently improve the information on NHS waiting times on the NHS Choices website. I'll give one example: for hip replacements at Basingstoke and North Hampshire hospital, the average time from GP referral to treatment is given as 10 weeks. This information is dated 18 June 2010. Last week, I was told I would have to wait 11 to 12 weeks just to get an outpatient appointment, with an unknown further wait for treatment. How can the government expect patients to make a fully informed choice with information which is so badly out of date?
George Donald
Hook, Hampshire